hospital_name,last_updated_on,version,location_name,hospital_address,type_2_npi,license_number|IL,attester_name,"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Hopedale Medical Complex,4/6/2026,3.0.0,Hopedale Medical Complex,"107 Tremont Street, Hopedale, IL, 61747",1992837298|1174569438,1024,Holly Anske,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, description,code|1,code|1|type,code|2,code|2|type,modifiers,drug_unit_of_measurement,drug_type_of_measurement,setting,standard_charge|gross,standard_charge|discounted_cash,standard_charge|Blue Cross Blue Shield of IL|Default|methodology,standard_charge|Blue Cross Blue Shield of IL|Default|negotiated_dollar,standard_charge|Blue Cross Blue Shield of IL|Default|negotiated_percentage,standard_charge|Blue Cross Blue Shield of IL|Default|negotiated_algorithm,median_amount|Blue Cross Blue Shield of IL|Default,10th_percentile|Blue Cross Blue Shield of IL|Default,90th_percentile|Blue Cross Blue Shield of IL|Default,count|Blue Cross Blue Shield of IL|Default,additional_payer_notes|Blue Cross Blue Shield of IL|Default,standard_charge|Cigna|Default|methodology,standard_charge|Cigna|Default|negotiated_dollar,standard_charge|Cigna|Default|negotiated_percentage,standard_charge|Cigna|Default|negotiated_algorithm,median_amount|Cigna|Default,10th_percentile|Cigna|Default,90th_percentile|Cigna|Default,count|Cigna|Default,additional_payer_notes|Cigna|Default,standard_charge|Medicare A IL J6|Select|methodology,standard_charge|Medicare A IL J6|Select|negotiated_dollar,standard_charge|Medicare A IL J6|Select|negotiated_percentage,standard_charge|Medicare A IL J6|Select|negotiated_algorithm,median_amount|Medicare A IL J6|Select,10th_percentile|Medicare A IL J6|Select,90th_percentile|Medicare A IL J6|Select,count|Medicare A IL J6|Select,additional_payer_notes|Medicare A IL J6|Select,standard_charge|Medicare B IL J6|Select|methodology,standard_charge|Medicare B IL J6|Select|negotiated_dollar,standard_charge|Medicare B IL J6|Select|negotiated_percentage,standard_charge|Medicare B IL J6|Select|negotiated_algorithm,median_amount|Medicare B IL J6|Select,10th_percentile|Medicare B IL J6|Select,90th_percentile|Medicare B IL J6|Select,count|Medicare B IL J6|Select,additional_payer_notes|Medicare B IL J6|Select,standard_charge|United Healthcare|Default|methodology,standard_charge|United Healthcare|Default|negotiated_dollar,standard_charge|United Healthcare|Default|negotiated_percentage,standard_charge|United Healthcare|Default|negotiated_algorithm,median_amount|United Healthcare|Default,10th_percentile|United Healthcare|Default,90th_percentile|United Healthcare|Default,count|United Healthcare|Default,additional_payer_notes|United Healthcare|Default,standard_charge|min,standard_charge|max,additional_generic_notes "GROUND MILEAGE, PER MILE",A0425,HCPCS,540,RC,,,,both,30.76,21.53,,,,,,,,,,,,,,,,,,,Other,9.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.14,9.14, ANESTH EXTERN MIDDLE & INNER EAR W/BX,120,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, MASTECTOMY SIMPLE UNILATERAL,19303,HCPCS,360,RC,,,,both,21716.46,15201.52,,,,,,,,,,,,,,,,,,,Other,4682.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,940.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,940.9,4682.07, "MASTECTOMY SIMPLE BILATERAL,BILATERAL",19303,HCPCS,360,RC,50,,,both,32574.69,22802.28,,,,,,,,,,,,,,,,,,,Other,7023.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1411.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1411.35,7023.1, VASECTOMY,55250,HCPCS,360,RC,,,,both,6401.86,4481.3,,,,,,,,,,,,,,,,,,,Other,1380.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,328.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,328.52,1380.24, CARDIO VASCULAR LEVEL 1,360,RC,,,,,,both,183.82,128.67,,,,,,,,,,,,,,,,,,,Other,39.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.63,39.63, CARDIO VASCULAR LEVEL 2,360,RC,,,,,,both,170.36,119.25,,,,,,,,,,,,,,,,,,,Other,36.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.73,36.73, CARDIO VASCULAR LEVEL 3,360,RC,,,,,,both,193.2,135.24,,,,,,,,,,,,,,,,,,,Other,41.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.65,41.65, CARDIO VASCULAR LEVEL 4,360,RC,,,,,,both,206.63,144.64,,,,,,,,,,,,,,,,,,,Other,44.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.55,44.55, CARDIO VASCULAR LEVEL 5,360,RC,,,,,,both,214.4,150.08,,,,,,,,,,,,,,,,,,,Other,46.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,46.23,46.23, ENDOCRINE LEVEL 1,360,RC,,,,,,both,167.12,116.98,,,,,,,,,,,,,,,,,,,Other,36.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.03,36.03, ENDOCRINE LEVEL 2,360,RC,,,,,,both,168.76,118.13,,,,,,,,,,,,,,,,,,,Other,36.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.39,36.39, ENDOCRINE LEVEL 3,360,RC,,,,,,both,189.92,132.94,,,,,,,,,,,,,,,,,,,Other,40.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.94,40.94, ENDOCRINE LEVEL 4,360,RC,,,,,,both,206.63,144.64,,,,,,,,,,,,,,,,,,,Other,44.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.55,44.55, ENDOCRINE LEVEL 5,360,RC,,,,,,both,214.4,150.08,,,,,,,,,,,,,,,,,,,Other,46.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,46.23,46.23, GASTROINTESTINAL LEVEL 1,360,RC,,,,,,both,167.12,116.98,,,,,,,,,,,,,,,,,,,Other,36.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.03,36.03, GASTROINTESTINAL LEVEL 2,360,RC,,,,,,both,168.75,118.13,,,,,,,,,,,,,,,,,,,Other,36.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.39,36.39, GASTROINTESTINAL LEVEL 3,360,RC,,,,,,both,189.92,132.94,,,,,,,,,,,,,,,,,,,Other,40.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.94,40.94, GASTROINTESTINAL LEVEL 4,360,RC,,,,,,both,203.39,142.37,,,,,,,,,,,,,,,,,,,Other,43.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.86,43.86, GASTROINTESTINAL LEVEL 5,360,RC,,,,,,both,211.15,147.81,,,,,,,,,,,,,,,,,,,Other,45.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,45.52,45.52, GYNECOLOGICAL LEVEL 1,360,RC,,,,,,both,167.12,116.98,,,,,,,,,,,,,,,,,,,Other,36.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.03,36.03, GYNECOLOGICAL LEVEL 2,360,RC,,,,,,both,168.75,118.13,,,,,,,,,,,,,,,,,,,Other,36.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.39,36.39, GYNECOLOGICAL LEVEL 3,360,RC,,,,,,both,189.92,132.94,,,,,,,,,,,,,,,,,,,Other,40.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.94,40.94, GYNECOLOGICAL LEVEL 4,360,RC,,,,,,both,203.39,142.37,,,,,,,,,,,,,,,,,,,Other,43.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.86,43.86, GYNECOLOGICAL LEVEL 5,360,RC,,,,,,both,211.15,147.81,,,,,,,,,,,,,,,,,,,Other,45.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,45.52,45.52, URINARY LEVEL 1,360,RC,,,,,,both,179.04,125.33,,,,,,,,,,,,,,,,,,,Other,38.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,38.6,38.6, URINARY LEVEL 2,360,RC,,,,,,both,185.43,129.8,,,,,,,,,,,,,,,,,,,Other,39.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.97,39.97, URINARY LEVEL 3,360,RC,,,,,,both,191.83,134.28,,,,,,,,,,,,,,,,,,,Other,41.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.36,41.36, URINARY LEVEL 4,360,RC,,,,,,both,200.77,140.54,,,,,,,,,,,,,,,,,,,Other,43.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.29,43.29, URINARY LEVEL 5,360,RC,,,,,,both,208.45,145.92,,,,,,,,,,,,,,,,,,,Other,44.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.94,44.94, INTEGUMENTARY LEVEL 1,360,RC,,,,,,both,160.69,112.48,,,,,,,,,,,,,,,,,,,Other,34.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.64,34.64, INTEGUMENTARY LEVEL 2,360,RC,,,,,,both,168.76,118.13,,,,,,,,,,,,,,,,,,,Other,36.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.39,36.39, INTEGUMENTARY LEVEL 3,360,RC,,,,,,both,189.92,132.94,,,,,,,,,,,,,,,,,,,Other,40.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.94,40.94, INTEGUMENTARY LEVEL 4,360,RC,,,,,,both,203.39,142.37,,,,,,,,,,,,,,,,,,,Other,43.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.86,43.86, INTEGUMENTARY LEVEL 5,360,RC,,,,,,both,211.15,147.81,,,,,,,,,,,,,,,,,,,Other,45.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,45.52,45.52, NEUROLOGICAL LEVEL 1,360,RC,,,,,,both,167.94,117.56,,,,,,,,,,,,,,,,,,,Other,36.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.21,36.21, NEUROLOGICAL LEVEL 2,360,RC,,,,,,both,169.55,118.69,,,,,,,,,,,,,,,,,,,Other,36.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.55,36.55, NEUROLOGICAL LEVEL 3,360,RC,,,,,,both,191.17,133.82,,,,,,,,,,,,,,,,,,,Other,41.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.22,41.22, NEUROLOGICAL LEVEL 4,360,RC,,,,,,both,203.39,142.37,,,,,,,,,,,,,,,,,,,Other,43.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.86,43.86, NEUROLOGICAL LEVEL 5,360,RC,,,,,,both,211.15,147.81,,,,,,,,,,,,,,,,,,,Other,45.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,45.52,45.52, RESPIRATORY LEVEL 1,360,RC,,,,,,both,167.12,116.98,,,,,,,,,,,,,,,,,,,Other,36.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.03,36.03, RESPIRATORY LEVEL 2,360,RC,,,,,,both,168.76,118.13,,,,,,,,,,,,,,,,,,,Other,36.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.39,36.39, RESPIRATORY LEVEL 3,360,RC,,,,,,both,189.92,132.94,,,,,,,,,,,,,,,,,,,Other,40.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.94,40.94, RESPIRATORY LEVEL 4,360,RC,,,,,,both,201.76,141.23,,,,,,,,,,,,,,,,,,,Other,43.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.5,43.5, RESPIRATORY LEVEL 5,360,RC,,,,,,both,218.88,153.22,,,,,,,,,,,,,,,,,,,Other,47.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.19,47.19, CANCEL LEVEL 1 PRIOR TO ANESTHESIA,360,RC,,,,,,both,51.25,35.88,,,,,,,,,,,,,,,,,,,Other,11.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.05,11.05, CANCEL LEVEL 2 PRIOR TO ANESTHESIA,360,RC,,,,,,both,51.75,36.23,,,,,,,,,,,,,,,,,,,Other,11.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.16,11.16, CANCEL LEVEL 3 PRIOR TO ANESTHESIA,360,RC,,,,,,both,58.5,40.95,,,,,,,,,,,,,,,,,,,Other,12.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.61,12.61, CANCEL LEVEL 4 PRIOR TO ANESTHESIA,360,RC,,,,,,both,62.5,43.75,,,,,,,,,,,,,,,,,,,Other,13.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.48,13.48, CANCEL LEVEL 5 PRIOR TO ANESTHESIA,360,RC,,,,,,both,61.75,43.23,,,,,,,,,,,,,,,,,,,Other,13.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.32,13.32, CANCEL LEVEL 1 AFTER ANESTH INDUCT,360,RC,,,,,,both,70.25,49.18,,,,,,,,,,,,,,,,,,,Other,15.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.15,15.15, CANCEL LEVEL 2 AFTER ANESTH INDUCT,360,RC,,,,,,both,69.5,48.65,,,,,,,,,,,,,,,,,,,Other,14.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.98,14.98, CANCEL LEVEL 3 AFTER ANESTH INDUCT,360,RC,,,,,,both,126.5,88.55,,,,,,,,,,,,,,,,,,,Other,27.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,27.27,27.27, CANCEL LEVEL 4 AFTER ANESTH INDUCT,360,RC,,,,,,both,129.5,90.65,,,,,,,,,,,,,,,,,,,Other,27.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,27.92,27.92, CANCEL LEVEL 5 AFTER ANESTH INDUCT,360,RC,,,,,,both,81,56.7,,,,,,,,,,,,,,,,,,,Other,17.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.46,17.46, BRONCHOSCOPY,360,RC,,,,,,both,5608.58,3926.01,,,,,,,,,,,,,,,,,,,Other,1209.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1209.21,1209.21, UPPER GI ENDOSCOPY,360,RC,,,,,,both,3913.53,2739.47,,,,,,,,,,,,,,,,,,,Other,843.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,843.76,843.76, PACU PHASE 1,710,RC,,,,,,both,58.93,41.25,,,,,,,,,,,,,,,,,,,Other,12.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.7,12.7, ASD PHASE 2 GENERAL,710,RC,,,,,,both,17.78,12.45,,,,,,,,,,,,,,,,,,,Other,3.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.83,3.83, EDG COLONOSCOPY W/ DILAT,360,RC,,,,,,both,6767,4736.9,,,,,,,,,,,,,,,,,,,Other,1458.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1458.97,1458.97, COLONOSCOPY,360,RC,,,,,,both,3913.53,2739.47,,,,,,,,,,,,,,,,,,,Other,843.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,843.76,843.76, EDG COLONOSCOPY,360,RC,,,,,,both,4940.5,3458.35,,,,,,,,,,,,,,,,,,,Other,1065.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1065.17,1065.17, ERCP,360,RC,,,,,,both,9772.94,6841.06,,,,,,,,,,,,,,,,,,,Other,2107.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2107.05,2107.05, SPINE LEVEL 1,360,RC,,,,,,both,169.96,118.97,,,,,,,,,,,,,,,,,,,Other,36.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.64,36.64, SPINE LEVEL 2,360,RC,,,,,,both,171.92,120.34,,,,,,,,,,,,,,,,,,,Other,37.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.06,37.06, SPINE LEVEL 3,360,RC,,,,,,both,199.99,139.99,,,,,,,,,,,,,,,,,,,Other,43.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.12,43.12, SPINE LEVEL 4,360,RC,,,,,,both,205.52,143.86,,,,,,,,,,,,,,,,,,,Other,44.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.31,44.31, SPINE LEVEL 5,360,RC,,,,,,both,256.79,179.75,,,,,,,,,,,,,,,,,,,Other,55.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,55.36,55.36, OPERATING MICROSCOPE ADD ON,69990,HCPCS,360,RC,,,,both,4339.75,3037.83,,,,,,,,,,,,,,,,,,,Other,935.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,216.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,216.39,935.66, OPERATING MICROSCOPE ADD ON,69990,HCPCS,360,RC,,,,both,4339.75,3037.83,,,,,,,,,,,,,,,,,,,Other,935.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,216.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,216.39,935.66, PAIN CLINIC LEVEL 2 BILAT,360,RC,,,,,,both,2224.36,1557.05,,,,,,,,,,,,,,,,,,,Other,479.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,479.57,479.57, PODIATRY LEVEL 1,360,RC,,,,,,both,141.64,99.15,,,,,,,,,,,,,,,,,,,Other,30.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,30.54,30.54, PODIATRY LEVEL 2,360,RC,,,,,,both,143.27,100.29,,,,,,,,,,,,,,,,,,,Other,30.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,30.89,30.89, PODIATRY LEVEL 3,360,RC,,,,,,both,166.66,116.66,,,,,,,,,,,,,,,,,,,Other,35.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.94,35.94, PODIATRY LEVEL 4,360,RC,,,,,,both,171.28,119.9,,,,,,,,,,,,,,,,,,,Other,36.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.93,36.93, PODIATRY LEVEL 5,360,RC,,,,,,both,185.44,129.81,,,,,,,,,,,,,,,,,,,Other,39.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.98,39.98, THORACENTESIS W/IMAGING,360,RC,,,,,,both,2003.46,1402.42,,,,,,,,,,,,,,,,,,,Other,431.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,431.94,431.94, MINOR PROCEDURE RAD,360,RC,,,,,,both,2914.11,2039.88,,,,,,,,,,,,,,,,,,,Other,628.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,628.28,628.28, MINOR PROCEDURE,360,RC,,,,,,both,3042.5,2129.75,,,,,,,,,,,,,,,,,,,Other,655.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,655.96,655.96, PAIN CLINIC PROCEDURE,360,RC,,,,,,outpatient,2668.6,1868.02,,,,,,,,,,,,,,,,,,,Other,575.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,575.35,575.35, PAIN CLINIC LEVEL 2,360,RC,,,,,,outpatient,3434.86,2404.4,,,,,,,,,,,,,,,,,,,Other,740.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,740.56,740.56, BEDSIDE PROCEDURE,360,RC,,,,,,both,2318.63,1623.04,,,,,,,,,,,,,,,,,,,Other,499.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,499.9,499.9, PILLCAM PLACEMENT,91110,HCPCS,750,RC,,,,both,2925.59,2047.91,,,,,,,,,,,,,,,,,,,Other,630.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,725.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,630.76,725.96, ASD NURSING SERVICE,99211,HCPCS,761,RC,,,,both,212.09,148.46,,,,,,,,,,,,,,,,,,,Other,45.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,22.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,22.54,45.73, CT GUIDED MINOR PROCEDURE,360,RC,,,,,,both,5266.34,3686.44,,,,,,,,,,,,,,,,,,,Other,1135.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1135.42,1135.42, KNEE ARTHROSCOPY,360,RC,,,,,,both,10593.71,7415.6,,,,,,,,,,,,,,,,,,,Other,2284.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2284.01,2284.01, ROTATOR CUFF REPAIR,360,RC,,,,,,both,21868.43,15307.9,,,,,,,,,,,,,,,,,,,Other,4714.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4714.83,4714.83, SHOULDER ARTHROSCOPY,360,RC,,,,,,both,21341.28,14938.9,,,,,,,,,,,,,,,,,,,Other,4601.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4601.18,4601.18, SHOULDER DECOMPRESSION DIS CLAVICAL,360,RC,,,,,,both,18983.6,13288.52,,,,,,,,,,,,,,,,,,,Other,4092.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4092.86,4092.86, TOPAZ TENOTOMY,360,RC,,,,,,both,11821.97,8275.38,,,,,,,,,,,,,,,,,,,Other,2548.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2548.81,2548.81, ARTHRODESIS,360,RC,,,,,,both,9491.27,6643.89,,,,,,,,,,,,,,,,,,,Other,2046.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2046.32,2046.32, BUNIONECTOMY,360,RC,,,,,,both,11714.67,8200.27,,,,,,,,,,,,,,,,,,,Other,2525.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2525.69,2525.69, CYSTOSCOPY,360,RC,,,,,,both,9190.96,6433.67,,,,,,,,,,,,,,,,,,,Other,1981.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1981.57,1981.57, LITHOTRIPSY,360,RC,,,,,,both,19274.21,13491.95,,,,,,,,,,,,,,,,,,,Other,4155.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4155.52,4155.52, BLADDER INSTILLATION,51700,HCPCS,360,RC,,,,both,353.75,247.63,,,,,,,,,,,,,,,,,,,Other,76.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,73.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,73.1,76.27, ESWL Rental,360,RC,,,,,,both,6510.48,4557.34,,,,,,,,,,,,,,,,,,,Other,1403.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1403.66,1403.66, CYSTO INSERTION TRANSPROSTATIC IMPLANT S,52441,HCPCS,360,RC,,,,both,6238.27,4366.79,,,,,,,,,,,,,,,,,,,Other,1344.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1135.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1135.44,1344.97, ADDL TRANSPROSTATIC IMPLANT,52442,HCPCS,360,RC,,,,both,1644.64,1151.25,,,,,,,,,,,,,,,,,,,Other,354.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,778.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,354.58,778.98, CYSTO W/ INSERT 1 TO 3 IMPLANTS MC,C9739,HCPCS,360,RC,,,,both,15517.27,10862.09,,,,,,,,,,,,,,,,,,,Other,3345.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3345.52,3345.52, CYSTO W/ INSERT TRANSPROSTATIC IMPLANT 4,C9740,HCPCS,360,RC,,,,both,30197.94,21138.56,,,,,,,,,,,,,,,,,,,Other,6510.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6510.68,6510.68, CYSTOSCOPY W/ URETEROSCOPY,360,RC,,,,,,both,16521.06,11564.74,,,,,,,,,,,,,,,,,,,Other,3561.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3561.94,3561.94, INFERIOR VENA CAVA FILTER,C1880,HCPCS,278,RC,,,,both,10319.34,7223.54,,,,,,,,,,,,,,,,,,,Other,2224.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2224.84,2224.84, MEDIPORT PLACEMENT,360,RC,,,,,,both,11351.29,7945.9,,,,,,,,,,,,,,,,,,,Other,2447.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2447.33,2447.33, LAPAROSCOPIC CHOLECYSTECTOMY,360,RC,,,,,,both,19111.55,13378.09,,,,,,,,,,,,,,,,,,,Other,4120.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4120.45,4120.45, LAPAROSCOPIC NISSEN FUNDOPLICATION,360,RC,,,,,,both,27130.19,18991.13,,,,,,,,,,,,,,,,,,,Other,5849.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5849.27,5849.27, LAPAROSCOPIC NISSEN CHOLECYSTECTOMY,360,RC,,,,,,both,27130.19,18991.13,,,,,,,,,,,,,,,,,,,Other,5849.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5849.27,5849.27, PACEMAKER GENERATOR REPLACEMENT,360,RC,,,,,,inpatient,28269.3,19788.51,,,,,,,,,,,,,,,,,,,Other,6094.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6094.86,6094.86, LAP PARAESOPHAG HERN REPAIR,360,RC,,,,,,both,33338.55,23336.99,,,,,,,,,,,,,,,,,,,Other,7187.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7187.79,7187.79, UMBILICAL HERNIA REPAIR,360,RC,,,,,,both,11233.97,7863.78,,,,,,,,,,,,,,,,,,,Other,2422.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2422.04,2422.04, CYSTO W/ LITHOTRIPSY,360,RC,,,,,,both,16535.79,11575.05,,,,,,,,,,,,,,,,,,,Other,3565.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3565.11,3565.11, US PV RESIDUAL URINE BLDR SCAN,51798,HCPCS,761,RC,,,,both,212.57,148.8,,,,,,,,,,,,,,,,,,,Other,45.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.78,45.83, PACU PHASE I AND PHASE II,360,RC,,,,,,both,2452.5,1716.75,,,,,,,,,,,,,,,,,,,Other,528.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,528.76,528.76, CENTRAL VENOUS CATHETER,360,RC,,,,,,both,5037.8,3526.46,,,,,,,,,,,,,,,,,,,Other,1086.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1086.15,1086.15, BRAVO PH MONITORING,91035,HCPCS,920,RC,,,,both,1872.04,1310.43,,,,,,,,,,,,,,,,,,,Other,403.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,457.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,403.61,457.08, ASD PHASE 2 MAC ANESTH,710,RC,,,,,,both,14.66,10.26,,,,,,,,,,,,,,,,,,,Other,3.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.17,3.17, ASD PHASE 2 SCOPE,710,RC,,,,,,both,676,473.2,,,,,,,,,,,,,,,,,,,Other,145.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,145.75,145.75, ESOPHAGEAL MANOMETRY,91010,HCPCS,750,RC,,,,both,1880,1316,,,,,,,,,,,,,,,,,,,Other,405.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,225.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,225.43,405.33, RESTECH GASTROESOPH REFLUX W NASAL PH,91034,HCPCS,750,RC,,,,both,1880,1316,,,,,,,,,,,,,,,,,,,Other,405.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,185.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,185.51,405.33, FLEXIBLE SIGMOIDOSCOPY,360,RC,,,,,,both,2728.85,1910.2,,,,,,,,,,,,,,,,,,,Other,588.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,588.34,588.34, LAP GASTROESOPH SPHINC AUG,360,RC,,,,,,both,27130.19,18991.13,,,,,,,,,,,,,,,,,,,Other,5849.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5849.27,5849.27, DESTRUCTION INTERNAL HEMORRHOID THERMAL,46930,HCPCS,360,RC,,,,both,3887.32,2721.12,,,,,,,,,,,,,,,,,,,Other,838.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,230.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,230.9,838.11, HOLMIUM LASER,360,RC,,,,,,both,3211.73,2248.21,,,,,,,,,,,,,,,,,,,Other,692.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,692.45,692.45, GREENLIGHT LASER,360,RC,,,,,,both,6273.77,4391.64,,,,,,,,,,,,,,,,,,,Other,1352.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1352.63,1352.63, 200 MICRON FIBER,360,RC,,,,,,both,1241.65,869.16,,,,,,,,,,,,,,,,,,,Other,267.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,267.7,267.7, EWSL UNILAT LITHOTRIPS RENTAL,360,RC,,,,,,both,7992,5594.4,,,,,,,,,,,,,,,,,,,Other,1723.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1723.08,1723.08, LAP NISSEN,43280,HCPCS,360,RC,,,,both,33338.55,23336.99,,,,,,,,,,,,,,,,,,,Other,7187.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1053.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1053.66,7187.79, LAP SLEEVE GASTRECTOMY,43775,HCPCS,360,RC,,,,both,16446.34,11512.44,,,,,,,,,,,,,,,,,,,Other,3545.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1063.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1063.26,3545.83, TAP BLOCK BILAT,64488,HCPCS,360,RC,,,,both,2438.6,1707.02,,,,,,,,,,,,,,,,,,,Other,525.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,138.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,138.54,525.76, NJX AA&/STRD BRACH PLEXUS,64415,HCPCS,360,RC,,,,both,3034.02,2123.81,,,,,,,,,,,,,,,,,,,Other,654.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,145.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,145.37,654.13, LAP APPENDECTOMY,360,RC,,,,,,both,11913.84,8339.69,,,,,,,,,,,,,,,,,,,Other,2568.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2568.62,2568.62, CARPAL TUNNEL - Non ORTHO,360,RC,,,,,,both,6565.16,4595.61,,,,,,,,,,,,,,,,,,,Other,1415.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1415.45,1415.45, INGUINAL HERNIA REPAIR,49505,HCPCS,360,RC,,,,both,11578.08,8104.66,,,,,,,,,,,,,,,,,,,Other,2496.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,520.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,520.27,2496.24, LESION REMOVAL 1-5 LESIONS,360,RC,,,,,,both,5164.45,3615.12,,,,,,,,,,,,,,,,,,,Other,1113.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1113.46,1113.46, LESION REMOVAL 6-10 LESIONA,360,RC,,,,,,both,10328.91,7230.24,,,,,,,,,,,,,,,,,,,Other,2226.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2226.91,2226.91, "LAP REPAIR VENTRAL, UMBILICAL, AND/OR EP",360,RC,,,,,,both,18433.65,12903.56,,,,,,,,,,,,,,,,,,,Other,3974.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3974.29,3974.29, NJX AA&/STRD FEM NERVE NFS,64448,HCPCS,360,RC,,,,both,2869.62,2008.73,,,,,,,,,,,,,,,,,,,Other,618.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,68.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,68.32,618.69, TOTAL ABDOMINAL HYSTERECTOMY (TAH),360,RC,,,,,,both,31469.36,22028.55,,,,,,,,,,,,,,,,,,,Other,6784.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6784.79,6784.79, SMALL BOWEL RESECTION,360,RC,,,,,,both,16874,11811.8,,,,,,,,,,,,,,,,,,,Other,3638.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3638.03,3638.03, BX BREAST 1ST LESION W IMG GUIDE,360,RC,,,,,,both,5193.24,3635.27,,,,,,,,,,,,,,,,,,,Other,1119.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1119.66,1119.66, NEEDLE BX LYMPH NODES,360,RC,,,,,,both,5193.24,3635.27,,,,,,,,,,,,,,,,,,,Other,1119.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1119.66,1119.66, REMOVE INT &/OR EXT HEMORRHOID,360,RC,,,,,,both,8898.59,6229.01,,,,,,,,,,,,,,,,,,,Other,1918.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1918.54,1918.54, "BX LYMPH NODES-AXLRY, CRVCL, INGNL",360,RC,,,,,,both,5193.24,3635.27,,,,,,,,,,,,,,,,,,,Other,1119.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1119.66,1119.66, PARTIAL RELEASE OF LUNG,32225,HCPCS,360,RC,,,,inpatient,9418.24,6592.77,,,,,,,,,,,,,,,,,,,Other,2030.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,989.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,989.91,2030.57, OPEN CHOLECYSTECTOMY,360,RC,,,,,,both,32454.64,22718.25,,,,,,,,,,,,,,,,,,,Other,6997.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6997.22,6997.22, REPAIR FEMORAL HERNIA,360,RC,,,,,,both,11415.88,7991.12,,,,,,,,,,,,,,,,,,,Other,2461.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2461.26,2461.26, THYROID BIOPSY,360,RC,,,,,,both,2321.59,1625.11,,,,,,,,,,,,,,,,,,,Other,500.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,500.54,500.54, BILAT INGUINAL HERNIA REPAIR,360,RC,,,,,,both,17367.12,12156.98,,,,,,,,,,,,,,,,,,,Other,3744.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3744.35,3744.35, FNA BX W/US 1ST LESION,360,RC,,,,,,both,2342.95,1640.07,,,,,,,,,,,,,,,,,,,Other,505.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,505.14,505.14, NEEDLE BX OF LIVER,360,RC,,,,,,both,5395.4,3776.78,,,,,,,,,,,,,,,,,,,Other,1163.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1163.25,1163.25, SCALENECTOMY,360,RC,,,,,,both,23788.62,16652.03,,,,,,,,,,,,,,,,,,,Other,5128.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5128.83,5128.83, CARDIOVERSION,360,RC,,,,,,both,4005.26,2803.68,,,,,,,,,,,,,,,,,,,Other,863.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,863.54,863.54, "NON-BILLABLE OBSERVATION HOURS,NONCOVERED",G0378,HCPCS,762,RC,GZ,,,both,106.21,74.35,,,,,,,,,,,,,,,,,,,Other,22.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.9,22.9, AMB SERV ALS NON-EMERG,A0426,HCPCS,540,RC,,,,both,1077.52,754.26,,,,,,,,,,,,,,,,,,,Other,320.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,320.55,320.55, AMB SERV BLS NON-EMERG,A0428,HCPCS,540,RC,,,,both,897.93,628.55,,,,,,,,,,,,,,,,,,,Other,267.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,267.12,267.12, ISOLATION,164,RC,,,,,,both,72.49,50.74,,,,,,,,,,,,,,,,,,,Per Diem,2826.98,,Reimbursement is subject to Medicare Sequestration.,,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,,,,,,,,,,2826.98,2826.98, AMB SERV ALS EMERG L1,A0427,HCPCS,540,RC,,,,both,1706.59,1194.61,,,,,,,,,,,,,,,,,,,Other,507.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,507.53,507.53, AMB SERV BLS EMERG TRANS,A0429,HCPCS,540,RC,,,,both,1436.39,1005.47,,,,,,,,,,,,,,,,,,,Other,427.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,427.4,427.4, AMB 02 & SUPPLIES- LIFE SUSTAIN,A0422,HCPCS,540,RC,,,,both,75,52.5,,,,,,,,,,,,,,,,,,,Other,16.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.17,16.17, LEVEL 1 OBSERVATION EACH ADDL HR,G0378,HCPCS,762,RC,,,,both,107.27,75.09,,,,,,,,,,,,,,,,,,,Other,23.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.13,23.13, LEVEL 2 OBSERVATION EACH ADDL HR,99222,HCPCS,762,RC,,,,both,138.05,96.64,,,,,,,,,,,,,,,,,,,Other,29.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,116.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,29.76,116.89, LEVEL 1 OBSERVATION FIRST HR,G0378,HCPCS,762,RC,,,,both,299.45,209.62,,,,,,,,,,,,,,,,,,,Other,64.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,64.56,64.56, LEVEL 2 OBSERVATION FIRST HR,99222,HCPCS,762,RC,,,,both,363.31,254.32,,,,,,,,,,,,,,,,,,,Other,78.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,116.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,78.33,116.89, PHASE II RECOVERY FIRST 1/2 HR,710,RC,,,,,,both,578.97,405.28,,,,,,,,,,,,,,,,,,,Other,124.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,124.82,124.82, PHASE II RECOVERY ADDL 1/2 HR,710,RC,,,,,,both,324.36,227.05,,,,,,,,,,,,,,,,,,,Other,69.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,69.93,69.93, EXTERNAL ELECTRICAL CARDIOVERSION,92960,HCPCS,480,RC,,,,both,1774.32,1242.02,,,,,,,,,,,,,,,,,,,Other,382.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,147.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,147.12,382.54, TEMPORARY TRANSCUTANEOUS PACING,92953,HCPCS,480,RC,,,,both,1818.68,1273.08,,,,,,,,,,,,,,,,,,,Other,392.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.14,392.11, ROUTINE VENIPUNCTURE,36415,HCPCS,300,RC,,,,both,122.97,86.08,,,,,,,,,,,,,,,,,,,Other,26.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.15,26.51, TRANSFUSION BLOOD PRODUCTS,36430,HCPCS,391,RC,,,,both,1377.32,964.12,,,,,,,,,,,,,,,,,,,Other,296.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,43.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,43.07,296.95, HYDRATION IV INFUSION INIT 31-60 MINS,96360,HCPCS,260,RC,,,,both,444.69,311.28,,,,,,,,,,,,,,,,,,,Other,95.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.59,95.87, HYDRATE IV INFUSION ADD-ON,96361,HCPCS,260,RC,,,,both,233.21,163.25,,,,,,,,,,,,,,,,,,,Other,50.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.12,50.28, THER/PROPH/DIAG IV INF INIT =<1 HR,96365,HCPCS,260,RC,,,,both,643.45,450.42,,,,,,,,,,,,,,,,,,,Other,138.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,61.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,61.51,138.73, THER/PROPH/DIAG IV INF ADDON,96366,HCPCS,260,RC,,,,both,226.64,158.65,,,,,,,,,,,,,,,,,,,Other,48.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.85,48.86, "IV PUSH, SEQUENTIAL, NEW DRUG",96375,HCPCS,260,RC,,,,both,188.31,131.82,,,,,,,,,,,,,,,,,,,Other,40.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.54,40.6, DIRECT REFERRAL FOR OBSERVATION SVCS,G0379,HCPCS,762,RC,,,,both,1927.75,1349.43,,,,,,,,,,,,,,,,,,,Other,415.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,415.63,415.63, INJECTION SC/IM,96372,HCPCS,260,RC,,,,both,223.5,156.45,,,,,,,,,,,,,,,,,,,Other,48.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.45,48.19, "IV PUSH, INITIAL",96374,HCPCS,260,RC,,,,both,330.55,231.39,,,,,,,,,,,,,,,,,,,Other,71.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.71,71.27, "IV PUSH, SEQUENTIAL, SAME DRUG+30 MIN",96376,HCPCS,260,RC,,,,both,192.53,134.77,,,,,,,,,,,,,,,,,,,Other,41.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.51,41.51, CARDIOPULMONARY RESUSCITATION,92950,HCPCS,480,RC,,,,both,839.15,587.41,,,,,,,,,,,,,,,,,,,Other,180.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,359.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,180.92,359.66, HEMOCCULT,82272,HCPCS,300,RC,,,,both,17.87,12.51,,,,,,,,,,,,,,,,,,,Other,3.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.85,4.15, FOLEY CATHETER INSERTION,51702,HCPCS,761,RC,,,,both,338.78,237.15,,,,,,,,,,,,,,,,,,,Other,73.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,61.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,61.46,73.04, STRAIGHT CATHETERIZATION,51701,HCPCS,761,RC,,,,both,347.24,243.07,,,,,,,,,,,,,,,,,,,Other,74.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,43.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,43.53,74.86, CAPILLARY BLOOD GLUCOSE,82948,HCPCS,300,RC,,,,both,29.95,20.97,,,,,,,,,,,,,,,,,,,Other,6.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.94,6.46, DECLOTTING BY THROMBOLYTIC AGENT,36593,HCPCS,761,RC,,,,both,760.89,532.62,,,,,,,,,,,,,,,,,,,Other,164.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.5,164.05, COLLECTION OF BLOOD FROM VENOUS ACC,36591,HCPCS,761,RC,,,,both,347.24,243.07,,,,,,,,,,,,,,,,,,,Other,74.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.41,74.86, IMMUNIZATION ADMIN 1 VACCINE,90471,HCPCS,771,RC,,,,both,161.12,112.78,,,,,,,,,,,,,,,,,,,Other,34.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.42,34.74, TX/PROPH/DG ADDL SEQ IV INF,96367,HCPCS,260,RC,,,,both,226.64,158.65,,,,,,,,,,,,,,,,,,,Other,48.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.35,48.86, IMMUNIZATION ADMIN EA ADDL,90472,HCPCS,771,RC,,,,both,97.31,68.12,,,,,,,,,,,,,,,,,,,Other,20.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.98,20.98, INITIAL HOSP IP/OBS LOW 40,99221,HCPCS,960,RC,,,,both,338.06,236.64,,,,,,,,,,,,,,,,,,,Other,86.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,75.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,75.33,86.63, INITIAL HOSP IP/OBS MODERATE 55,99222,HCPCS,960,RC,,,,both,385.62,269.93,,,,,,,,,,,,,,,,,,,Other,134.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,116.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,116.89,134.43, INITIAL HOSP IP/OBS HIGH 75,99223,HCPCS,960,RC,,,,both,655.76,459.03,,,,,,,,,,,,,,,,,,,Other,179.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,155.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,155.79,179.16, HOSP IP/OBS SAME DAY DC LOW 45,99234,HCPCS,960,RC,,,,both,471.47,330.03,,,,,,,,,,,,,,,,,,,Other,101.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,88.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,88.43,101.68, HOSP IP/OBS SAME DAY DC LOW 45,99235,HCPCS,960,RC,,,,both,602.19,421.53,,,,,,,,,,,,,,,,,,,Other,163.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,142.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,142.45,163.82, HOSP IP/OBS DC SAME DAY HIGH 85,99236,HCPCS,761,RC,,,,both,748.45,523.92,,,,,,,,,,,,,,,,,,,Other,161.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,189.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,161.37,189.65, HOPS IP/OBS DSCHRG MGMT 30<,99238,HCPCS,960,RC,,,,both,221.67,155.17,,,,,,,,,,,,,,,,,,,Other,84.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,73.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,73.76,84.83, HOSP IP/OBS DSCHRG MGMT >30,99239,HCPCS,762,RC,,,,both,330.55,231.39,,,,,,,,,,,,,,,,,,,Other,71.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,71.27,104.86, IP/OBS CONSULT SF 35,99245,HCPCS,969,RC,,,,both,169.3,118.51,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, IP/OBS CONSULT LOW 45,99253,HCPCS,988,RC,,,,both,330.55,231.39,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, IP/OBS CONSULT MOD 60,99254,HCPCS,969,RC,,,,both,437.6,306.32,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, "OP VISIT, EST PT, LEVEL 1",99211,HCPCS,761,RC,,,,both,212.09,148.46,,,,,,,,,,,,,,,,,,,Other,45.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,22.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,22.54,45.73, "OP VISIT, EST PT 10 MIN OR MORE",99212,HCPCS,510,RC,,,,both,88,61.6,,,,,,,,,,,,,,,,,,,Other,18.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,56.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.97,56.47, BLADDER INSTILLATION,51700,HCPCS,510,RC,,,,both,353.75,247.63,,,,,,,,,,,,,,,,,,,Other,76.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,73.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,73.1,76.27, THER/PROPH/DIAG INJ SC/IM,96372,HCPCS,510,RC,,,,both,161.12,112.78,,,,,,,,,,,,,,,,,,,Other,34.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.45,34.74, HYDRATION IV INFUSION INIT 31-60 MINS,96360,HCPCS,260,RC,,,,both,444.69,311.28,,,,,,,,,,,,,,,,,,,Other,95.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.59,95.87, HYDRATE IV INFUSION ADD-ON,96361,HCPCS,260,RC,,,,both,233.21,163.25,,,,,,,,,,,,,,,,,,,Other,50.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.12,50.28, THER/PROPH/DIAG IV INF INIT =<1 HR,96365,HCPCS,260,RC,,,,both,643.45,450.42,,,,,,,,,,,,,,,,,,,Other,138.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,61.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,61.51,138.73, THER/PROPH/DIAG IV INF ADDON,96366,HCPCS,260,RC,,,,both,226.64,158.65,,,,,,,,,,,,,,,,,,,Other,48.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.85,48.86, THER/PROPH/DIAG INJ IV PUSH,96374,HCPCS,260,RC,,,,both,343.3,240.31,,,,,,,,,,,,,,,,,,,Other,74.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.71,74.02, TX/PRO/DX INJ SAME DRUG ADDON,96376,HCPCS,510,RC,,,,both,131.65,92.16,,,,,,,,,,,,,,,,,,,Other,28.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28.38,28.38, "IV PUSH, SEQUENTIAL, NEW DRUG",96375,HCPCS,260,RC,,,,both,152.77,106.94,,,,,,,,,,,,,,,,,,,Other,32.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.54,32.94, IMMUNIZATION ADMIN 1 VACCINE,90471,HCPCS,771,RC,,,,both,161.12,112.78,,,,,,,,,,,,,,,,,,,Other,34.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.42,34.74, BLOOD COLLECTION/IMPLANTABLE DEVICE,36591,HCPCS,510,RC,,,,both,347.24,243.07,,,,,,,,,,,,,,,,,,,Other,74.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.41,74.86, IMPLANTED DEVICE DECLOTTING,36593,HCPCS,510,RC,,,,both,760.89,532.62,,,,,,,,,,,,,,,,,,,Other,164.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.5,164.05, CAPILLARY BLOOD GLUCOSE,82962,HCPCS,300,RC,,,,both,29.29,20.5,,,,,,,,,,,,,,,,,,,Other,6.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.21,6.31, FOLEY CATHETER INSERTION,51702,HCPCS,510,RC,,,,both,338.78,237.15,,,,,,,,,,,,,,,,,,,Other,73.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,61.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,61.46,73.04, "OCCULT BLOOD,FECES,SINGLE-DIAGNOSTIC",82272,HCPCS,300,RC,,,,both,17.88,12.52,,,,,,,,,,,,,,,,,,,Other,3.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.85,4.15, "IV INFUSION, CONCURRENT",96368,HCPCS,260,RC,,,,both,233.5,163.45,,,,,,,,,,,,,,,,,,,Other,50.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.23,50.34, IRRIGATION VAD/PORT FLUSH,96523,HCPCS,260,RC,,,,both,218.18,152.73,,,,,,,,,,,,,,,,,,,Other,47.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.64,47.04, "IV INFUSION, SEQUENTIAL NEW",96367,HCPCS,260,RC,,,,both,231.71,162.2,,,,,,,,,,,,,,,,,,,Other,49.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.35,49.96, IMMUNIZATION ADMINISTRATION EA ADDL,90472,HCPCS,771,RC,,,,both,97.31,68.12,,,,,,,,,,,,,,,,,,,Other,20.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.98,20.98, Hosp OP Clinic Visit - MC,G0463,HCPCS,761,RC,,,,both,218.18,152.73,,,,,,,,,,,,,,,,,,,Other,47.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.04,47.04, ANESTH CATHETERIZED HEART,1920,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,84.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,84.02,136.11, ANES LWR INTST SCR COLSC,812,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANESTH DX ARTERIOGRAPHY,1916,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANES UPR GI NDSC PX NOS,731,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANES TX INTERV RAD HRT/CRAN,1926,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,95.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,95.85,136.11, ANES LWR INTST NDSC NOS,811,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH VASCULAR ACCESS,532,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH SURG UPPER ABDOMEN,790,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,84.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,84.02,136.11, ANESTH CAT OR MRI SCAN,1922,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,84.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,84.02,136.11, ANESTH LOWER ARM SURGERY,1810,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANES UPR LWR GI NDSC PX,813,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH SKIN EXT/PER/ATRUNK,400,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANESTH BURN LESS 4 PERCENT,1951,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANESTH BURN 4-9 PERCENT,1952,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH BURN EACH 9 PERCENT,1953,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,13.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,22.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.01,22.64, ANESTH HIP JOINT PROCEDURE,1200,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH CHEST PROCEDURE,520,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,72.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,125.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.19,125.54, ANESTH ANORECTAL SURGERY,902,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH THIGH ARTERIES SURG,1270,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,1.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.19,2.06, ANESTH NECK ORGAN 1YR/>,320,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,72.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,125.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.19,125.54, ANESTH HIP ARTHROPLASTY,1214,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,95.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,95.85,136.11, ANESTH LOWER LEG BONE SURG,1480,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANESTH UPPER LEG SURGERY,1250,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH KNEE SRTERIES SURG,1440,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,95.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,95.85,136.11, ANESTH HYSTERECTOMY,846,HCPCS,964,RC,,,,inpatient,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,95.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,95.85,136.11, ANESTH PERINEAL SURGERY,904,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,84.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,84.02,136.11, ANESTH HEAD/NECK/PTRUNK,300,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH REPAIR OF HERNIA,752,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,72.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,125.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.19,125.54, ANESTH CHEST DRAINAGE,524,HCPCS,964,RC,,,,inpatient,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH LOWER LEG VEIN SURG NOS,1520,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANESTH FOR LIVER BIOPSY,702,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH SURGERY OF SHOULDER NOS,1630,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH UPPER LEG VEINS SURG,1260,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANESTH KNEE JOINT CASTING,1420,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANESTH ADBOMINAL WALL SURG UPPER POST,730,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH ACHILLES TENDON SURG,1472,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH SALIVARY GLAND,100,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH N BLOCK/INJ PRONE,1992,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH ABDO WALL SURG UPPER ANT NOS,700,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH REPAIR OF HERNIA LOWER NOS,830,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH HEART SURG W/O PUMP,560,HCPCS,964,RC,,,,inpatient,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,178.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.11,178.68, ANESTH BLOOD VESSEL REPAIR,770,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,178.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.11,178.68, ANESTH NECK VESSEL SURGERY NOS,350,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,119.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,119.52,136.11, ANESTH LOWER LEG SURGERY NOS,1470,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANESTH ESOPHAGEAL SURGERY,500,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,178.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.11,178.68, ANESTH VAGINAL PROCEDURES,940,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANESTH CERV SPINE CORD SURGERY,600,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,119.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,119.52,136.11, ANESTH SITTING PROCEDURE,604,HCPCS,964,RC,,,,inpatient,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,155.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.11,155.02, ANESTH DRG/ASPIR LMBR/SAC,1938,HCPCS,964,RC,,,,both,134.84,94.39,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH HIP JOINT SURGERY,1210,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,72.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,125.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.19,125.54, ANESTH SURGERY OF FEMUR,1230,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,72.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,125.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.19,125.54, ANESTH KNEE ARTHROPLASTY,1402,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,84.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,84.02,136.11, ANESTH BLADDER SURGERY,910,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANESTH EXT SPINE CORD SURGERY,670,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,155.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.11,155.02, ANESTH SURGERY OF BREAST RADICAL,404,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH KIDNEY/URETER SURG,862,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,84.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,84.02,136.11, ANESTH KNEE JOINT SURGERY,1400,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH FAT LAYER REMOVAL,802,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH SURG LOWER ABDOMEN,840,HCPCS,963,RC,,,,both,198,138.6,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,125.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,125.54,125.54, ANESTH SURG LOWER ABDOMEN,840,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,72.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,125.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.19,125.54, ANESTH LOWER ARM PROCEDURE,1820,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANESTH CHEST SURGERY,540,HCPCS,964,RC,,,,inpatient,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,143.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.11,143.19, ANESTH BONE ASPIRATE/BX,1112,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH PROCEDURES ON EYE,140,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH VASCULAR SHUNT SURG,1844,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,72.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,125.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.19,125.54, NJX INTERLAMINAR LMBR/SAC,62322,HCPCS,964,RC,,,,both,887.48,621.24,,,,,,,,,,,,,,,,,,,Other,84.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,137.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,84.91,137.79, ANESTH SHOULDER PROCEDURE,1620,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH ABDO WALL SURG LOWER ANT NOS,800,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANES THER INTERVEN RAD ART,1924,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH KNEE AREA SURGERY,1320,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH REPAIR OF HERNIA V&A,832,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,72.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,125.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.19,125.54, ANESTH LUMBAR SPINE CORD SURGERY,630,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,95.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,95.85,136.11, ANESTH FEMORAL EMBOLECTOMY,1274,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,72.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,125.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.19,125.54, ANES TX INTERV RAD TH VEIN,1932,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,72.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,125.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.19,125.54, ANESTH REMOVAL OF PROSTATE RESECTION,914,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANES MEDIASCPY & DX THORSCPY,528,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,95.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,95.85,136.11, TAP BLOCK BI INJECTION,64488,HCPCS,963,RC,,,,both,888.15,621.71,,,,,,,,,,,,,,,,,,,Other,65.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,138.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.85,138.54, ANESTH VASECTOMY,921,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANESTH BLADDER TUMOR SURG,912,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH KNEE AREA SURGERY UPPER,1392,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH GENITALIA SURGERY,920,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, TRANSURETHRAL PROCEDURE,918,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH THORACOTOMY W 1 LUNG VENT,541,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,178.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.11,178.68, ANESTH SHOULDER REPLACEMENT,1638,HCPCS,964,RC,,,,inpatient,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,119.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,119.52,136.11, ANESTH LOWER ARM SURGERY NOS,1830,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANESTH SURGERY FOR OBESITY,1797,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,1.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.19,2.06, ANESTH LOWER LEG PROCEDURE,1462,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANESTH ELBOW AREA SURGERY,1710,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANESTH CHEST LINING BIOPSY,522,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH SPINE CORD SURGERY,620,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,119.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,119.52,136.11, ANESTH ARM-LEG VESSEL SURG,1656,HCPCS,964,RC,,,,inpatient,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,119.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,119.52,136.11, ANESTH ABDOMEN VESSEL SURG,880,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,178.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.11,178.68, ANESTH NERVE BLOCK/INJ,1991,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANESTH REMOVAL OF TESTIS INGUINAL,926,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH SURGERY OF ABDOMEN,860,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,72.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,125.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.19,125.54, ANESTH AMPUTATION OF FEMUR,1232,HCPCS,964,RC,,,,inpatient,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH CLOSED PROCEDURE KNEE JOINT,1380,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANESTH PROCEDURE ON BONY PELVIS,1120,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,72.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,125.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.19,125.54, ANESTH SURGERY OF SHOULDER,1610,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH BLADDER STONE SURG,870,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH SKULL DRAINAGE,214,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,107.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,107.68,136.11, ANESTH UPPER ARM SURGERY,1740,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH KIDNEY STONE DESTRUCT,873,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH REPAIR OF HERNIA,750,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH KNEE AREA SURGERY,1360,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH PANCREAS REMOVAL,794,HCPCS,964,RC,,,,inpatient,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,95.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,95.85,136.11, ANESTH BABG WO PUMP,566,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,297.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.11,297.02, ANESTH FOR PERCUT IMAGE-GUIDE DESTRUCTIO,1940,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH FOR PERCUT IMAGE-GUIDE NEUROMODUL,1942,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH FOR PERM TRANS PACEMAKER INSERT,530,HCPCS,964,RC,,,,both,134.84,94.39,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH FOR THERAPEUTIC INTERV RADIOLOGIC,1925,HCPCS,964,RC,,,,both,134.84,94.39,,,,,,,,,,,,,,,,,,,Other,84.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,132.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,84.02,132.14, ANESTH FOR PROCEDURES ON MALE GENITALIA,920,HCPCS,964,RC,,,,both,134.84,94.39,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANESTH FOR PROC ON MAJ NECK VESS SIMP LI,352,HCPCS,964,RC,,,,both,134.84,94.39,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH FOR PROC IN LUMBAR REGION; DX OR,635,HCPCS,964,RC,,,,both,134.84,94.39,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH FOR INTRACRANIAL PROCEDURES; CERE,220,HCPCS,964,RC,,,,both,134.84,94.39,,,,,,,,,,,,,,,,,,,Other,119.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,132.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,119.52,132.14, ANESTH FOR PERCUTANEOUS IMAGE-GUIDE SPIN,1939,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH FOR VAGINAL PROCEUDRES,952,HCPCS,964,RC,,,,both,134.84,94.39,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, FEMORAL/ADD NERVE BLOCK,963,RC,,,,,,both,2306.1,1614.27,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ANESTH PERQ IMG NEUROMD/NTRVRT PX SP C/T,1941,HCPCS,964,RC,,,,both,246.82,172.77,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANES ESOPH THYRD LARX TRACH & LYMPH NECK,322,HCPCS,964,RC,,,,both,96.35,67.45,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.06,2.06, ANESTHESIA FIRST 15 MINS,370,RC,,,,,,both,1056.48,739.54,,,,,,,,,,,,,,,,,,,Other,227.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,227.78,227.78, ANESTHESIA EACH ADDITIONAL MINUTE,370,RC,,,,,,both,70.46,49.32,,,,,,,,,,,,,,,,,,,Other,15.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.19,15.19, THORACIC EPIDURAL,370,RC,,,,,,both,2199.29,1539.5,,,,,,,,,,,,,,,,,,,Other,474.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,474.16,474.16, ANESTH FOR THORACOTOMY PROC,542,HCPCS,963,RC,,,,inpatient,134.84,94.39,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,132.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,132.14,132.14, ANESTH NOSE/SINUS SURGERY,160,HCPCS,964,RC,,,,both,127.79,89.45,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH FOR VAGINAL/URETHRAL PROC,942,HCPCS,964,RC,,,,both,37.48,26.24,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.73,48.52, ANESTH DX KNEE ARTHROSCOPY,1382,HCPCS,964,RC,,,,both,153.81,107.67,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,63.8, ANESTH RADICAL LEG SURGERY,1482,HCPCS,964,RC,,,,both,138.89,97.22,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH CLAVICLE/SCAPULA,450,HCPCS,964,RC,,,,both,240.13,168.09,,,,,,,,,,,,,,,,,,,Other,60.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,104.96, ANESTH KNEE ARTERY REPAIR,1444,HCPCS,964,RC,,,,both,240.13,168.09,,,,,,,,,,,,,,,,,,,Other,95.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,166.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,95.85,166.7, ANESTH CORRECT HEART RHYTHM,410,HCPCS,964,RC,,,,both,156.1,109.27,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,84.38, ANESTH CLSD SPINE MANIPULATION,640,HCPCS,964,RC,,,,both,38.5,26.95,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,37.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.68,37.73, ANESTH REMOVAL OF RIB,470,HCPCS,964,RC,,,,both,762.25,533.58,,,,,,,,,,,,,,,,,,,Other,72.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,125.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.19,125.54, "IV PUSH, SEQUENTIAL, NEW DRUG",96375,HCPCS,450,RC,,,,both,152.77,106.94,,,,,,,,,,,,,,,,,,,Other,32.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.54,32.94, INJECTION SC/IM,96372,HCPCS,450,RC,,,,both,161.12,112.78,,,,,,,,,,,,,,,,,,,Other,34.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.45,34.74, "HYDRATION IV,INITIAL,31MIN TO 1HR",96360,HCPCS,450,RC,,,,both,444.69,311.28,,,,,,,,,,,,,,,,,,,Other,95.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.59,95.87, "HYDRATION IV, ADDL HR",96361,HCPCS,450,RC,,,,both,233.21,163.25,,,,,,,,,,,,,,,,,,,Other,50.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.12,50.28, "IV INFUSION, INITIAL, UP TO 1 HR",96365,HCPCS,450,RC,,,,both,643.45,450.42,,,,,,,,,,,,,,,,,,,Other,138.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,61.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,61.51,138.73, "IV INFUSION, ADDL HR",96366,HCPCS,450,RC,,,,both,226.64,158.65,,,,,,,,,,,,,,,,,,,Other,48.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.85,48.86, "IV PUSH, INITIAL",96374,HCPCS,450,RC,,,,both,327.98,229.59,,,,,,,,,,,,,,,,,,,Other,70.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.71,70.72, "IV PUSH, SEQUENTIAL, SAME DRUG",96376,HCPCS,450,RC,,,,both,188.31,131.82,,,,,,,,,,,,,,,,,,,Other,40.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.6,40.6, "IV INFUSION, CONCURRENT",96368,HCPCS,450,RC,,,,both,141.38,98.97,,,,,,,,,,,,,,,,,,,Other,30.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.23,30.48, IV PUSH INITIAL DRUG,96374,HCPCS,260,RC,,,,both,680.05,476.04,,,,,,,,,,,,,,,,,,,Other,146.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.71,146.62, "IV INFUSION, SEQUENT, UP TO 1 HR",96367,HCPCS,450,RC,,,,both,226.64,158.65,,,,,,,,,,,,,,,,,,,Other,48.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.35,48.86, CYSTOSTOMY TUBE CHANGE,51705,HCPCS,450,RC,,,,both,802.68,561.88,,,,,,,,,,,,,,,,,,,Other,173.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,95.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,95.61,173.06, APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1,15271,HCPCS,761,RC,,,,both,5827.47,4079.23,,,,,,,,,,,,,,,,,,,Other,1256.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,149.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,149.98,1256.4, APP SKN SUB GRFT T/A/L AREA/100SQ CM EA,15272,HCPCS,761,RC,,,,both,1385.88,970.12,,,,,,,,,,,,,,,,,,,Other,298.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.99,298.79, SKIN SUB GRFT T/ARM/LG CHILD,15273,HCPCS,761,RC,,,,both,10691.86,7484.3,,,,,,,,,,,,,,,,,,,Other,2305.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,310.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,310.99,2305.17, APP SKN SUB GRFT T/A/L AREA>=100SCM ADL,15274,HCPCS,761,RC,,,,both,2416.19,1691.33,,,,,,,,,,,,,,,,,,,Other,520.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,83.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,83.54,520.93, SUB GRFT F/S/N/H/F/G/M/D<100SQ CM 1ST 25,15275,HCPCS,761,RC,,,,both,5996.46,4197.52,,,,,,,,,,,,,,,,,,,Other,1292.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,152.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,152.77,1292.84, SUB GRFT F/S/N/H/F/G/M/D<100SQ CM EA ADD,15276,HCPCS,761,RC,,,,both,1808.5,1265.95,,,,,,,,,,,,,,,,,,,Other,389.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,33.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,33.07,389.91, SKN SUB GRFT F/N/H/F/G CH ADD,15278,HCPCS,761,RC,,,,both,3046.54,2132.58,,,,,,,,,,,,,,,,,,,Other,656.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,97.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,97.6,656.84, CHEMICAL CAUTERIZATION,17250,HCPCS,450,RC,,,,both,448.75,314.13,,,,,,,,,,,,,,,,,,,Other,96.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,83.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,83.57,96.76, SUB GRFT F/S/N/H/F/G/M/D>=100SCM 1STSQ C,15277,HCPCS,761,RC,,,,both,5827.47,4079.23,,,,,,,,,,,,,,,,,,,Other,1256.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,349.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,349.27,1256.4, DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM,11042,HCPCS,761,RC,,,,both,1210.19,847.13,,,,,,,,,,,,,,,,,,,Other,260.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,124.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,124.21,260.92, DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ,11045,HCPCS,761,RC,,,,both,665.4,465.78,,,,,,,,,,,,,,,,,,,Other,143.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,40.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,40.24,143.46, RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANE,97602,HCPCS,761,RC,,,,both,660.85,462.6,,,,,,,,,,,,,,,,,,,Other,142.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,142.48,142.48, NEGATIVE PRESSURE WOUND THERAPY DME <= 5,97605,HCPCS,510,RC,,,,both,660.85,462.6,,,,,,,,,,,,,,,,,,,Other,142.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,39.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,39.41,142.48, NEGATIVE PRESSURE WOUND THERAPY DME <= 5,97606,HCPCS,761,RC,,,,both,1210.2,847.14,,,,,,,,,,,,,,,,,,,Other,260.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,47.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,47.02,260.92, DEBR EXZ INF SKIN 10% BS,11000,HCPCS,450,RC,,,,both,1683.45,1178.42,,,,,,,,,,,,,,,,,,,Other,362.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,55.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,55.64,362.95, DRS&/DBRDMT PRTL-THKNS BURNS 1,16030,HCPCS,450,RC,,,,both,1114.38,780.07,,,,,,,,,,,,,,,,,,,Other,240.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,206.19,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,206.19,240.26, I&D ABSCESS:COMPLIC/MX,10061,HCPCS,450,RC,,,,both,869.33,608.53,,,,,,,,,,,,,,,,,,,Other,187.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,210.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,187.42,210.77, I&D ABSCESS; PERINEUM,56405,HCPCS,450,RC,,,,both,1050.17,735.12,,,,,,,,,,,,,,,,,,,Other,226.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,140.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,140.26,226.42, REP ET HAND; W FG EA TENDON,26412,HCPCS,450,RC,,,,both,10073.11,7051.18,,,,,,,,,,,,,,,,,,,Other,2171.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,665.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,665.95,2171.76, ROUTINE VENIPUNCTURE,36415,HCPCS,300,RC,,,,both,119.39,83.57,,,,,,,,,,,,,,,,,,,Other,25.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.15,25.74, "COLLECT BLOOD, COMPL IMPLANT VAD",36591,HCPCS,450,RC,,,,both,347.24,243.07,,,,,,,,,,,,,,,,,,,Other,74.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.41,74.86, EXC BEN LES SCALP; 0.5 CM/LESS,11420,HCPCS,450,RC,,,,both,3499.85,2449.9,,,,,,,,,,,,,,,,,,,Other,754.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,116.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,116.96,754.57, INJ TRIGGER POINT 1/2 MUSCL,20552,HCPCS,450,RC,,,,both,858.27,600.79,,,,,,,,,,,,,,,,,,,Other,185.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,49.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,49.64,185.04, AVULS OF NAIL PLATE PART OR COMPL SIMPLE,11730,HCPCS,450,RC,,,,both,437.79,306.45,,,,,,,,,,,,,,,,,,,Other,94.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,94.38,104.42, I&D ABCESS; SIMPL/SNGL,10060,HCPCS,450,RC,,,,both,448.75,314.13,,,,,,,,,,,,,,,,,,,Other,96.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,121.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,96.76,121.22, FNA BX W/O IMG GDN 1ST LES,10021,HCPCS,761,RC,,,,both,1172.66,820.86,,,,,,,,,,,,,,,,,,,Other,252.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,96.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,96.08,252.83, INCS & REMOV FB SUBQ TISS; SIMPL,10120,HCPCS,450,RC,,,,both,823.6,576.52,,,,,,,,,,,,,,,,,,,Other,177.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,147.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,147.13,177.57, PUNCT ASPIR ABSCES/HEMAT/BULL/CYST,10160,HCPCS,450,RC,,,,both,849.6,594.72,,,,,,,,,,,,,,,,,,,Other,183.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,124.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,124.63,183.17, EXC TR-EXT B9+MARG 1.1-2 CM,11402,HCPCS,450,RC,,,,both,2254.16,1577.91,,,,,,,,,,,,,,,,,,,Other,486,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,160.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,160.86,486, EVACUATION SUBUNGUAL HEMATOMA,11740,HCPCS,450,RC,,,,both,207.66,145.36,,,,,,,,,,,,,,,,,,,Other,44.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,53.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,44.78,53.07, EXC NAIL/MATRIX PART/COMPLT PERM,11750,HCPCS,450,RC,,,,both,869.33,608.53,,,,,,,,,,,,,,,,,,,Other,187.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,148.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,148.42,187.42, REPR NAIL BED,11760,HCPCS,450,RC,,,,both,1725.53,1207.87,,,,,,,,,,,,,,,,,,,Other,372.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,175.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,175.63,372.03, SIMPL REPR SCLP/TRUNK; 2.5 CM/LESS,12001,HCPCS,450,RC,,,,both,635.2,444.64,,,,,,,,,,,,,,,,,,,Other,136.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,108.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,108.07,136.95, SIMPL REPR SCLP/TRUNK; 2.6-7.5 CM,12002,HCPCS,450,RC,,,,both,635.2,444.64,,,,,,,,,,,,,,,,,,,Other,136.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,132.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,132.89,136.95, SIMPL REPR SCLP/TRUNK; 7.6-12.5 CM,12004,HCPCS,450,RC,,,,both,635.2,444.64,,,,,,,,,,,,,,,,,,,Other,136.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,155.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.95,155.95, SREP S/N/A/G/TR/E; 12.6-20.0CM,12005,HCPCS,450,RC,,,,both,1265.13,885.59,,,,,,,,,,,,,,,,,,,Other,272.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,203.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,203.49,272.76, SIMPL REPR FACE/MUCOUS; 2.5/LESS,12011,HCPCS,450,RC,,,,both,635.2,444.64,,,,,,,,,,,,,,,,,,,Other,136.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,132.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,132.77,136.95, SR FCE/EAR/EYE/INSE/LIP 2.6-5,12013,HCPCS,450,RC,,,,both,635.2,444.64,,,,,,,,,,,,,,,,,,,Other,136.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,139.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.95,139.43, SIMPL REPR FACE/MUCOUS 5.1-7.5CM,12014,HCPCS,450,RC,,,,both,635.2,444.64,,,,,,,,,,,,,,,,,,,Other,136.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,166.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.95,166.23, SIMPL REPR FACE/MUCOUS 7.60-12.50CM,12015,HCPCS,450,RC,,,,both,635.2,444.64,,,,,,,,,,,,,,,,,,,Other,136.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,203.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.95,203.43, LAYER CLO SCLP/TRUNK; 2.5 CM/LESS,12031,HCPCS,450,RC,,,,both,1265.13,885.59,,,,,,,,,,,,,,,,,,,Other,272.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,242.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,242.95,272.76, LAYER CLO SCLP/TRUNK;2.6 TO 7.5CM,12032,HCPCS,450,RC,,,,both,1265.13,885.59,,,,,,,,,,,,,,,,,,,Other,272.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,280.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,272.76,280.91, LAYER CLO SCLP/TRUNK; 7.6 TP 12.5,12034,HCPCS,450,RC,,,,both,1265.13,885.59,,,,,,,,,,,,,,,,,,,Other,272.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,316,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,272.76,316, INTMD WND REPAIR S/A/T/EXT,12035,HCPCS,450,RC,,,,both,1265.13,885.59,,,,,,,,,,,,,,,,,,,Other,272.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,393.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,272.76,393.48, INTMD WND REPAIR N-HF/GENIT,12042,HCPCS,450,RC,,,,both,1265.13,885.59,,,,,,,,,,,,,,,,,,,Other,272.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,286.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,272.76,286.98, LAYER CLO FACE/LIPS; 2.5CM/LESS,12051,HCPCS,450,RC,,,,both,1265.13,885.59,,,,,,,,,,,,,,,,,,,Other,272.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,265.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,265.77,272.76, INTMD WND REPAIR FACE/MM 2.6-5.0 CM,12052,HCPCS,450,RC,,,,both,1265.13,885.59,,,,,,,,,,,,,,,,,,,Other,272.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,294.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,272.76,294.33, INTMD WND REPAIR FACE/MM 7.6-12.5 CM,12054,HCPCS,450,RC,,,,both,1265.13,885.59,,,,,,,,,,,,,,,,,,,Other,272.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,370.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,272.76,370.81, REPR COMPLX SCLP/EXTREM; 2.6-7.5CM,13121,HCPCS,450,RC,,,,both,1992.67,1394.87,,,,,,,,,,,,,,,,,,,Other,429.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,394.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,394.33,429.62, C REP S/A/L; EA ADD 5 CM/<,13122,HCPCS,450,RC,,,,both,836,585.2,,,,,,,,,,,,,,,,,,,Other,180.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,123.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,123.22,180.24, REPR COMPLX FOREHEAD/AX/FT; 1.1-2.5,13131,HCPCS,450,RC,,,,both,1592.68,1114.88,,,,,,,,,,,,,,,,,,,Other,343.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,363.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,343.38,363.49, REPR COMPLX FOREHEAD/AX/FT; 2.6-7.5CM,13132,HCPCS,450,RC,,,,both,1992.67,1394.87,,,,,,,,,,,,,,,,,,,Other,429.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,437.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,429.62,437.73, DSG/DEBRID INIT/SUBSQT; WO ANES SM,16020,HCPCS,450,RC,,,,both,448.75,314.13,,,,,,,,,,,,,,,,,,,Other,96.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,87.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,87.6,96.76, EXPLO PENTR WOUND (SEP PRO); EXTREM,20103,HCPCS,450,RC,,,,both,2181.59,1527.11,,,,,,,,,,,,,,,,,,,Other,470.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,566.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,470.35,566.62, ARTHROCENTESIS/ASPRI/INJ; INTERM JT,20605,HCPCS,450,RC,,,,both,831.37,581.96,,,,,,,,,,,,,,,,,,,Other,179.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,54.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,54.68,179.24, ARTHROCENTESIS MAJOR JT/BURSA,20610,HCPCS,450,RC,,,,both,831.37,581.96,,,,,,,,,,,,,,,,,,,Other,179.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,66.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,66.52,179.24, CLO TX SHLDR DISLOC W/MANIP;WO ANES,23650,HCPCS,450,RC,,,,both,640.27,448.19,,,,,,,,,,,,,,,,,,,Other,138.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,415.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,138.04,415.45, "CL TX ""NURSEMAID ELBOW"" W MANIP",24640,HCPCS,450,RC,,,,both,818.41,572.89,,,,,,,,,,,,,,,,,,,Other,176.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,98.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,98.21,176.45, CL TX RADIAL & ULNA FX W MANIP,25565,HCPCS,450,RC,,,,both,5040.18,3528.13,,,,,,,,,,,,,,,,,,,Other,1086.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,602.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,602.06,1086.66, CLOSED TREATMENT DISRAL RADIAL FRACTURE,25605,HCPCS,450,RC,,,,both,4634.33,3244.03,,,,,,,,,,,,,,,,,,,Other,999.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,614.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,614.31,999.16, DRAINAGE FINGER ABSCESS; SIMPL,26010,HCPCS,450,RC,,,,both,290.56,203.39,,,,,,,,,,,,,,,,,,,Other,62.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,284.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,62.64,284.75, CL TX D PHAL FX FGRR/THMB; W MANIP,26755,HCPCS,450,RC,,,,both,761.01,532.71,,,,,,,,,,,,,,,,,,,Other,164.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,364.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,164.07,364.42, CLO TX IP JT DISLOC W/WMANIP; WO ANES,26770,HCPCS,450,RC,,,,both,656.29,459.4,,,,,,,,,,,,,,,,,,,Other,141.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,347.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,141.49,347.08, CLO TX PATELLAR DISLOC; WO ANES,27560,HCPCS,450,RC,,,,both,761,532.7,,,,,,,,,,,,,,,,,,,Other,164.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,447.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,164.07,447.94, CLO TX TRIMALLEOLAR ANK FX; W/MANIP,27818,HCPCS,450,RC,,,,both,4636.31,3245.42,,,,,,,,,,,,,,,,,,,Other,999.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,565.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,565.69,999.59, CL TX FX GT PHALANX(S); W MANIP,28495,HCPCS,450,RC,,,,both,761,532.7,,,,,,,,,,,,,,,,,,,Other,164.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,184.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,164.07,184.05, APPLY LONG ARM CAST,29065,HCPCS,450,RC,,,,both,885.91,620.14,,,,,,,,,,,,,,,,,,,Other,191,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,102.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,102.86,191, APPLIC; ELBOW TO FINGER,29075,HCPCS,450,RC,,,,both,791.67,554.17,,,,,,,,,,,,,,,,,,,Other,170.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,92.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,92.37,170.69, APPLIC; LONG ARM SPLINT,29105,HCPCS,450,RC,,,,both,500,350,,,,,,,,,,,,,,,,,,,Other,107.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,92.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,92.81,107.8, APPLIC; SHORT ARM SPLINT; STATOC,29125,HCPCS,450,RC,,,,both,405.29,283.7,,,,,,,,,,,,,,,,,,,Other,87.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,74.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,74.14,87.38, APPLY FINGER SPLINT; STATIC,29130,HCPCS,450,RC,,,,both,405.29,283.7,,,,,,,,,,,,,,,,,,,Other,87.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,44.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,44.34,87.38, STRAPPING; SHOULDER,29240,HCPCS,450,RC,,,,both,397.56,278.29,,,,,,,,,,,,,,,,,,,Other,85.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27,85.71, APPLIC LONG LEG CAST,29345,HCPCS,450,RC,,,,both,852.08,596.46,,,,,,,,,,,,,,,,,,,Other,183.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,142.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,142.72,183.71, APPLIC SHORT LEG CAST,29425,HCPCS,450,RC,,,,both,903.63,632.54,,,,,,,,,,,,,,,,,,,Other,194.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,76.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,76.46,194.82, APPLIC LONG LEG SPLINT,29505,HCPCS,450,RC,,,,both,500,350,,,,,,,,,,,,,,,,,,,Other,107.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,102.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,102.69,107.8, APPLIC SHORT LEG SPLINT,29515,HCPCS,450,RC,,,,both,500,350,,,,,,,,,,,,,,,,,,,Other,107.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,78.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,78.39,107.8, REMOV/BIVALV; FULL ARM/LEG CAST,29705,HCPCS,450,RC,,,,both,791.67,554.17,,,,,,,,,,,,,,,,,,,Other,170.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,67.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,67.03,170.69, REMOV FB INTRANASAL; RIGHT,30300,HCPCS,450,RC,,,,both,413.67,289.57,,,,,,,,,,,,,,,,,,,Other,89.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,196.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,89.19,196.79, CNTRL POST EPISTAX INIT,30905,HCPCS,450,RC,,,,both,392.19,274.53,,,,,,,,,,,,,,,,,,,Other,84.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,367.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,84.55,367.61, INTUBATION ENDOTRACHEAL EMER PROC,31500,HCPCS,450,RC,,,,both,674.4,472.08,,,,,,,,,,,,,,,,,,,Other,145.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,137.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,137.5,145.4, CONTROL NASAL HEMORR ANT SIMP,30901,HCPCS,450,RC,,,,both,371.61,260.13,,,,,,,,,,,,,,,,,,,Other,80.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,155.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,80.12,155.32, INCS THROMBOSED HEMORRHOID EXT,46083,HCPCS,450,RC,,,,both,874.11,611.88,,,,,,,,,,,,,,,,,,,Other,188.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,211.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,188.45,211.7, SPINAL PUNCT LUMBAR DX,62270,HCPCS,450,RC,,,,both,1884.41,1319.09,,,,,,,,,,,,,,,,,,,Other,406.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,157.19,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,157.19,406.28, INJ ANES AGENT; OTHER PERIPHERAL,64450,HCPCS,450,RC,,,,both,1931.52,1352.06,,,,,,,,,,,,,,,,,,,Other,416.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,75.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,75.89,416.43, REMOV FB EXT EYE; CONJUNC SUPERF,65205,HCPCS,450,RC,,,,both,368.68,258.08,,,,,,,,,,,,,,,,,,,Other,79.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.89,79.49, REMOV FB EXT EYE;CORNEAL WO LAMP,65220,HCPCS,450,RC,,,,both,400.75,280.53,,,,,,,,,,,,,,,,,,,Other,86.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,61.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,61.26,86.41, REMOV EMBEDDED FB EYELID,67938,HCPCS,450,RC,,,,both,1022.49,715.74,,,,,,,,,,,,,,,,,,,Other,220.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,230.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,220.45,230.75, CTRL POST EPISTAX SQ,30906,HCPCS,450,RC,,,,both,769.65,538.76,,,,,,,,,,,,,,,,,,,Other,165.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,380.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,165.93,380.25, DRAIN EXT EAR ABSCESS; SIMPL,69000,HCPCS,450,RC,,,,both,2163.04,1514.13,,,,,,,,,,,,,,,,,,,Other,466.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,180.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,180.59,466.35, DRAIN EXT EAR ABSCESS; SIMPL,69000,HCPCS,981,RC,,,,both,572.69,400.88,,,,,,,,,,,,,,,,,,,Other,131.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,180.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,131.39,180.59, "IMMUN ADMIN, ONE VACCINE",90471,HCPCS,771,RC,,,,both,161.12,112.78,,,,,,,,,,,,,,,,,,,Other,34.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.42,34.74, ADMIN PNEUMONIA VACCINE- MC,G0009,HCPCS,771,RC,,,,both,161.12,112.78,,,,,,,,,,,,,,,,,,,Other,34.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.74,34.74, IMMUNIZATION ADMIN EA ADDL,90472,HCPCS,771,RC,,,,both,95.18,66.63,,,,,,,,,,,,,,,,,,,Other,20.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.98,20.52, CARDIOPULMONARY RESUSCITATION,92950,HCPCS,450,RC,,,,both,839.15,587.41,,,,,,,,,,,,,,,,,,,Other,180.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,359.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,180.92,359.66, TEMPORARY TRANSCUTANEOUS PACING,92953,HCPCS,450,RC,,,,both,1778.81,1245.17,,,,,,,,,,,,,,,,,,,Other,383.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.14,383.51, "CARDIOVERSION ELECTIVE, EXTERN",92960,HCPCS,450,RC,,,,both,1735.43,1214.8,,,,,,,,,,,,,,,,,,,Other,374.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,147.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,147.12,374.15, I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX,46040,HCPCS,761,RC,,,,both,3803.63,2662.54,,,,,,,,,,,,,,,,,,,Other,820.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,604.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,604.39,820.06, "ER VISIT, LEVEL 1",99281,HCPCS,450,RC,,,,outpatient,281.68,197.18,,,,,,,,,,,,,,,,,,,Other,60.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.21,60.73, "ER VISIT, LEVEL 2",99282,HCPCS,450,RC,,,,outpatient,518.91,363.24,,,,,,,,,,,,,,,,,,,Other,111.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,41.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,41.15,111.88, "ER VISIT, LEVEL 3",99283,HCPCS,450,RC,,,,outpatient,905.26,633.68,,,,,,,,,,,,,,,,,,,Other,195.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,70.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,70.97,195.18, "ER VISIT, LEVEL 4",99284,HCPCS,450,RC,,,,outpatient,1405.26,983.68,,,,,,,,,,,,,,,,,,,Other,302.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,121.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,121.04,302.98, "ER VISIT, LEVEL 5",99285,HCPCS,450,RC,,,,outpatient,2047.93,1433.55,,,,,,,,,,,,,,,,,,,Other,441.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,174.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,174.91,441.53, "CRITICAL CARE, 1ST 30-74 MIN",99291,HCPCS,450,RC,,,,both,2815.44,1970.81,,,,,,,,,,,,,,,,,,,Other,607.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,299.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,299.04,607.01, "CRITICAL CARE, ADDL 30 MIN",99292,HCPCS,450,RC,,,,both,1261.46,883.02,,,,,,,,,,,,,,,,,,,Other,271.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,131.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,131.14,271.97, "OCCULT BLOOD, FECES, SINGLE-DIAGNOSTIC",82272,HCPCS,300,RC,,,,both,17.88,12.52,,,,,,,,,,,,,,,,,,,Other,3.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.85,4.15, INTMD WND REPAIR N-HF/GENIT,12041,HCPCS,450,RC,,,,both,1265.13,885.59,,,,,,,,,,,,,,,,,,,Other,272.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,246.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,246.35,272.76, TB INTERDERMAL TEST,86580,HCPCS,300,RC,,,,both,48.36,33.85,,,,,,,,,,,,,,,,,,,Other,10.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.07,10.07, THROMBOLYSIS CORONARY; IV INFUSION,93799,HCPCS,450,RC,,,,both,760.89,532.62,,,,,,,,,,,,,,,,,,,Other,164.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,164.05,164.05, CATH URETHRA; SIMPL,51701,HCPCS,450,RC,,,,both,347.24,243.07,,,,,,,,,,,,,,,,,,,Other,74.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,43.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,43.53,74.86, "GLUCOSE,QUANT,BLD REAGENT STRP",82962,HCPCS,300,RC,,,,both,29.29,20.5,,,,,,,,,,,,,,,,,,,Other,6.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.21,6.31, INSERTION TEMPORARY INDWELLING BLADDER,51702,HCPCS,450,RC,,,,both,338.78,237.15,,,,,,,,,,,,,,,,,,,Other,73.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,61.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,61.46,73.04, UNLISTED PX NERVOUS SYSTEM,64999,HCPCS,360,RC,,,,both,950.89,665.62,,,,,,,,,,,,,,,,,,,Other,205.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,205.02,205.02, REMOVE IMPACTED EAR WAX UNI,69209,HCPCS,450,RC,,,,both,207.76,145.43,,,,,,,,,,,,,,,,,,,Other,44.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.45,44.8, US PV RESIDUAL URINE BLDR SCAN,51798,HCPCS,450,RC,,,,both,213.12,149.18,,,,,,,,,,,,,,,,,,,Other,45.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.78,45.95, APPLICATION OF FINGER SPLINT: DYNAMIC,29131,HCPCS,450,RC,,,,both,208.7,146.09,,,,,,,,,,,,,,,,,,,Other,44.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,56.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,44.99,56.44, APPY PATELLAR TENDON BEARING CAST,29435,HCPCS,450,RC,,,,both,879.57,615.7,,,,,,,,,,,,,,,,,,,Other,189.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,133.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,133.01,189.64, I & D BARTHOLIN'S GLAND,56420,HCPCS,450,RC,,,,both,669.9,468.93,,,,,,,,,,,,,,,,,,,Other,144.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,171.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,144.43,171.97, ER PHYSICIAN CRITICAL CARE 1ST HOUR,99291,HCPCS,981,RC,,,,outpatient,1867.04,1306.93,,,,,,,,,,,,,,,,,,,Other,230.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,299.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,230.82,299.04, FINE NEEDLE ASPIRATION W/O GUIDANCE,10021,HCPCS,960,RC,,,,both,526.5,368.55,,,,,,,,,,,,,,,,,,,Other,54.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,96.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,54.13,96.08, I&D ABCESS; SIMPL/SNGL,10060,HCPCS,981,RC,,,,both,417.82,292.47,,,,,,,,,,,,,,,,,,,Other,110.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,121.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,110.52,121.22, I&D ABSCESS:COMPLIC/MX,10061,HCPCS,981,RC,,,,both,819.09,573.36,,,,,,,,,,,,,,,,,,,Other,194.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,210.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,194.28,210.77, INCS & REMOV FB SUBQ TISS; SIMPL,10120,HCPCS,981,RC,,,,both,501.2,350.84,,,,,,,,,,,,,,,,,,,Other,112.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,147.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,112.48,147.13, PUNCT ASPIR ABSCES/HEMAT/BULL/CYST,10160,HCPCS,981,RC,,,,both,406.84,284.79,,,,,,,,,,,,,,,,,,,Other,102.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,124.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,102.09,124.63, EXC TR-EXT B9+MARG 1.1-2 CM,11402,HCPCS,981,RC,,,,both,521.71,365.2,,,,,,,,,,,,,,,,,,,Other,114.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,160.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,114.52,160.86, EXC BEN LES SCALP; 0.5 CM/LESS,11420,HCPCS,981,RC,,,,both,388.7,272.09,,,,,,,,,,,,,,,,,,,Other,84.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,116.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,84.32,116.96, AVULS OF NAIL PLATE PART OR COMPL SIMPLE,11730,HCPCS,981,RC,,,,both,303.84,212.69,,,,,,,,,,,,,,,,,,,Other,55.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,55.47,104.42, EVACUATION SUBUNGUAL HEMATOMA,11740,HCPCS,981,RC,,,,both,164.13,114.89,,,,,,,,,,,,,,,,,,,Other,34.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,53.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.21,53.07, EXC NAIL/MATRIX PART/COMPLT PERM,11750,HCPCS,981,RC,,,,both,869.33,608.53,,,,,,,,,,,,,,,,,,,Other,105.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,148.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,105.39,148.42, REPR NAIL BED,11760,HCPCS,981,RC,,,,both,726.88,508.82,,,,,,,,,,,,,,,,,,,Other,116.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,175.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,116.74,175.63, SIMPL REPR SCLP/TRUNK; 2.6-7.5 CM,12002,HCPCS,981,RC,,,,both,705.39,493.77,,,,,,,,,,,,,,,,,,,Other,68.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,132.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,68.62,132.89, SIMPL REPR SCLP/TRUNK; 7.6-12.5 CM,12004,HCPCS,981,RC,,,,both,849.99,594.99,,,,,,,,,,,,,,,,,,,Other,86.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,155.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,86.9,155.95, SIMPL REPR SCLP/TRUNK; 12.6-20.0CM,12005,HCPCS,981,RC,,,,both,1110.84,777.59,,,,,,,,,,,,,,,,,,,Other,109.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,203.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,109.26,203.49, SIMPL REPR FACE/MUCOUS; 2.5/LESS,12011,HCPCS,981,RC,,,,both,695.92,487.14,,,,,,,,,,,,,,,,,,,Other,65.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,132.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.05,132.77, SR FCE/EAR/EYE/INSE/LIP 2.6-5,12013,HCPCS,981,RC,,,,both,776.62,543.63,,,,,,,,,,,,,,,,,,,Other,67.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,139.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,67.9,139.43, SIMPL REPR FACE/MUCOUS 5.1-7.5CM,12014,HCPCS,981,RC,,,,both,935.96,655.17,,,,,,,,,,,,,,,,,,,Other,88.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,166.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,88.05,166.23, LAYER CLO SCLP/TRUNK; 2.5 CM/LESS,12031,HCPCS,981,RC,,,,both,882.63,617.84,,,,,,,,,,,,,,,,,,,Other,149.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,242.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,149.15,242.95, LAYER CLO SCLP/TRUNK;2.6 TO 7.5CM,12032,HCPCS,981,RC,,,,both,923.26,646.28,,,,,,,,,,,,,,,,,,,Other,184.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,280.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,184.2,280.91, LAYER CLO SCLP/TRUNK; 7.6 TP 12.5,12034,HCPCS,981,RC,,,,both,1040.32,728.22,,,,,,,,,,,,,,,,,,,Other,204.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,316,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,204.28,316, LAYER CLO UNSPECIF,12035,HCPCS,981,RC,,,,both,1339.46,937.62,,,,,,,,,,,,,,,,,,,Other,257.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,393.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,257.3,393.48, INTMD WND REPAIR N-HF/GENIT,12041,HCPCS,981,RC,,,,both,849.99,594.99,,,,,,,,,,,,,,,,,,,Other,145.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,246.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,145.83,246.35, LAYER CLO NECK/FT/GENIT; 2.6-7.5,12042,HCPCS,981,RC,,,,both,944.75,661.33,,,,,,,,,,,,,,,,,,,Other,189.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,286.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,189.46,286.98, LAYER CLO FACE/LIPS; 2.5CM/LESS,12051,HCPCS,981,RC,,,,both,943.78,660.65,,,,,,,,,,,,,,,,,,,Other,168.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,265.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,168.16,265.77, LAYER CLO FACE/LIPS; 7.6 TO 12.5CM,12054,HCPCS,981,RC,,,,both,1337.51,936.26,,,,,,,,,,,,,,,,,,,Other,226.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,370.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,226.42,370.81, REPR COMPLX SCLP/EXTREM; 2.6-7.5CM,13121,HCPCS,981,RC,,,,both,1347.28,943.1,,,,,,,,,,,,,,,,,,,Other,245.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,394.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,245.22,394.33, C REP S/A/L; EA ADD 5 CM/<,13122,HCPCS,981,RC,,,,both,488.5,341.95,,,,,,,,,,,,,,,,,,,Other,79.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,123.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,79.49,123.22, REPR COMPLX FOREHEAD/AX/FT; 1.1-2.5,13131,HCPCS,981,RC,,,,both,1274,891.8,,,,,,,,,,,,,,,,,,,Other,232.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,363.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,232.44,363.49, REPR COMPLX FOREHEAD/AX/FT; 2.6-7.5CM,13132,HCPCS,981,RC,,,,both,1647.92,1153.54,,,,,,,,,,,,,,,,,,,Other,286.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,437.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,286.19,437.73, DSG/DEBRID INIT/SUBSQT; WO ANES SM,16020,HCPCS,981,RC,,,,both,290.6,203.42,,,,,,,,,,,,,,,,,,,Other,61.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,87.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,61.22,87.6, DRS&/DBRDMT PRTL-THKNS BURNS 1,16030,HCPCS,981,RC,,,,both,727.68,509.38,,,,,,,,,,,,,,,,,,,Other,143.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,206.19,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,143.65,206.19, EXPLO PENTR WOUND (SEP PRO); EXTREM,20103,HCPCS,981,RC,,,,both,4296.52,3007.56,,,,,,,,,,,,,,,,,,,Other,368.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,566.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,368.07,566.62, INJ TRIGGER POINT 1/2 MUSCL,20552,HCPCS,981,RC,,,,both,248.07,173.65,,,,,,,,,,,,,,,,,,,Other,40.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,49.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,40.58,49.64, ARTHROCENTESIS/ASPRI/INJ; INTERM JT,20605,HCPCS,981,RC,,,,both,250.36,175.25,,,,,,,,,,,,,,,,,,,Other,37.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,54.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,37.11,54.68, ARTHROCENTESIS MAJOR JT/BURSA,20610,HCPCS,981,RC,,,,both,318.97,223.28,,,,,,,,,,,,,,,,,,,Other,46.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,66.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,46.6,66.52, CLO TX SHLDR DISLOC W/MANIP;WO ANES,23650,HCPCS,981,RC,,,,both,647.63,453.34,,,,,,,,,,,,,,,,,,,Other,409.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,415.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,409.72,415.45, "CL TX ""NURSEMAID ELBOW"" W MANIP",24640,HCPCS,981,RC,,,,both,558.95,391.27,,,,,,,,,,,,,,,,,,,Other,79.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,98.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,79.25,98.21, CL TX RADIAL & ULNA FX W MANIP,25565,HCPCS,981,RC,,,,both,5040.18,3528.13,,,,,,,,,,,,,,,,,,,Other,575.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,602.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,575.17,602.06, CLOSED TREATMENT DISRAL RADIAL FRACTURE,25605,HCPCS,981,RC,,,,both,2252.16,1576.51,,,,,,,,,,,,,,,,,,,Other,618.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,614.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,614.31,618.81, DRAINAGE FINGER ABSCESS; SIMPL,26010,HCPCS,450,RC,,,,both,265.62,185.93,,,,,,,,,,,,,,,,,,,Other,57.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,260.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,57.27,260.31, ER REPAIR EXT. TENDON FINGER PRI/SEC,26418,HCPCS,981,RC,,,,both,3088.82,2162.17,,,,,,,,,,,,,,,,,,,Other,680.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,592.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,592.05,680.86, CLO TX IP JT DISLOC W/WMANIP; WO ANES,26770,HCPCS,981,RC,,,,both,1123.75,786.63,,,,,,,,,,,,,,,,,,,Other,343.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,347.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,343.46,347.08, CLO TX PATELLAR DISLOC; WO ANES,27560,HCPCS,981,RC,,,,both,1515.12,1060.58,,,,,,,,,,,,,,,,,,,Other,444.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,447.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,444.67,447.94, CLO TX TRIMALLEOLAR ANK FX; W/MANIP,27818,HCPCS,981,RC,,,,both,2382.24,1667.57,,,,,,,,,,,,,,,,,,,Other,538.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,565.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,538.84,565.69, APPLY LONG ARM CAST,29065,HCPCS,981,RC,,,,both,642.76,449.93,,,,,,,,,,,,,,,,,,,Other,73.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,102.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,73.27,102.86, APPLIC; ELBOW TO FINGER,29075,HCPCS,981,RC,,,,both,401.91,281.34,,,,,,,,,,,,,,,,,,,Other,66.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,92.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,66.37,92.37, APPLIC; LONG ARM SPLINT,29105,HCPCS,981,RC,,,,both,431.22,301.85,,,,,,,,,,,,,,,,,,,Other,45.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,92.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,45.55,92.81, APPLIC; SHORT ARM SPLINT; STATIC,29125,HCPCS,981,RC,,,,both,271.56,190.09,,,,,,,,,,,,,,,,,,,Other,46.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,74.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,46.08,74.14, APPLY FINGER SPLINT; STATIC,29130,HCPCS,981,RC,,,,both,163.14,114.2,,,,,,,,,,,,,,,,,,,Other,30.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,44.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.03,44.34, STRAPPING; SHOULDER,29240,HCPCS,981,RC,,,,both,126,88.2,,,,,,,,,,,,,,,,,,,Other,17.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.3,27, APPLIC LONG LEG CAST,29345,HCPCS,981,RC,,,,both,603.46,422.42,,,,,,,,,,,,,,,,,,,Other,105.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,142.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,105.02,142.72, APPLIC SHORT LEG CAST,29405,HCPCS,981,RC,,,,both,399.58,279.71,,,,,,,,,,,,,,,,,,,Other,63.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,83.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,63.13,83.58, APPLIC LONG LEG SPLINT,29505,HCPCS,981,RC,,,,both,390.97,273.68,,,,,,,,,,,,,,,,,,,Other,61.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,102.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,61.74,102.69, APPLIC SHORT LEG SPLINT,29515,HCPCS,981,RC,,,,both,332.79,232.95,,,,,,,,,,,,,,,,,,,Other,56.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,78.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,56.48,78.39, REMOV/BIVALV; FULL ARM/LEG CAST,29705,HCPCS,981,RC,,,,both,346.85,242.8,,,,,,,,,,,,,,,,,,,Other,47.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,67.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,47.54,67.03, CONTRL NASAL HEMORR-ANT-SIMPL,30901,HCPCS,981,RC,,,,both,420.69,294.48,,,,,,,,,,,,,,,,,,,Other,59.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,155.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,59.36,155.32, CNTRL POST EPISTAX INIT,30905,HCPCS,981,RC,,,,both,585.6,409.92,,,,,,,,,,,,,,,,,,,Other,117.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,367.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,117.9,367.61, INTUBATION ENDOTRACHEAL EMER PROC,31500,HCPCS,981,RC,,,,both,788.6,552.02,,,,,,,,,,,,,,,,,,,Other,158.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,137.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,137.5,158.13, ART CATH-SAMPL (SEP PRO); PERG,36620,HCPCS,981,RC,,,,both,363.25,254.28,,,,,,,,,,,,,,,,,,,Other,47.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,40.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,40.95,47.1, INCS THROMBOSED HEMORRHOID EXT,46083,HCPCS,981,RC,,,,both,846.02,592.21,,,,,,,,,,,,,,,,,,,Other,122.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,211.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,122.14,211.7, INSERTION TEMPORARY INDWELLING BLADDER,51702,HCPCS,981,RC,,,,both,351.04,245.73,,,,,,,,,,,,,,,,,,,Other,26.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,61.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.69,61.46, CYSTOSTOMY TUBE CHANGE,51705,HCPCS,981,RC,,,,both,388.7,272.09,,,,,,,,,,,,,,,,,,,Other,54.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,95.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,54.27,95.61, I&D ABSCESS; PERINEUM,56405,HCPCS,981,RC,,,,both,490.96,343.67,,,,,,,,,,,,,,,,,,,Other,131.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,140.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,131.4,140.26, SPINAL PUNCT LUMBAR DX,62270,HCPCS,981,RC,,,,both,624.2,436.94,,,,,,,,,,,,,,,,,,,Other,71.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,157.19,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,71.48,157.19, INJ ANES AGENT; OTHER PERIPHERAL,64450,HCPCS,981,RC,,,,both,308.17,215.72,,,,,,,,,,,,,,,,,,,Other,43.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,75.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,43.63,75.89, REMOV FB EXT EYE; CONJUNC SUPERF,65205,HCPCS,981,RC,,,,both,185.82,130.07,,,,,,,,,,,,,,,,,,,Other,27.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.89,27.15, REMOV FB EXT EYE;CORNEAL WO LAMP,65220,HCPCS,981,RC,,,,both,185.48,129.84,,,,,,,,,,,,,,,,,,,Other,43.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,61.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,43.3,61.26, REM FB EXT AUDITORY CANAL; WO ANESTH,69200,HCPCS,981,RC,,,,both,371.45,260.02,,,,,,,,,,,,,,,,,,,Other,48.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,77.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.11,77.69, REMOVE EMBEDDED FB EYLID,67938,HCPCS,981,RC,,,,both,984.3,689.01,,,,,,,,,,,,,,,,,,,Other,109,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,230.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,109,230.75, SIMPL REPR FACE/MUCOUS 7.60-12.50 cm,12015,HCPCS,981,RC,,,,both,1153.83,807.68,,,,,,,,,,,,,,,,,,,Other,109.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,203.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,109.89,203.43, INTMD WND REPAIR FACE/MM 2.6-5.0 CM,12052,HCPCS,981,RC,,,,both,1037.57,726.3,,,,,,,,,,,,,,,,,,,Other,195.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,294.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,195.18,294.33, SIMPL REPR SCLP/TRUNK; 2.5 CM/LESS,12001,HCPCS,981,RC,,,,both,597.91,418.54,,,,,,,,,,,,,,,,,,,Other,52.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,108.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,52.45,108.07, CHEMICAL CAUTERIZATION PRO FEE,17250,HCPCS,981,RC,,,,both,162.02,113.41,,,,,,,,,,,,,,,,,,,Other,39.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,83.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,39.75,83.57, CL TX D PHAL FX FGRR/THMB; W MANIP,26755,HCPCS,981,RC,,,,both,1276.09,893.26,,,,,,,,,,,,,,,,,,,Other,334.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,364.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,334.89,364.42, DEBR EXZ INF SKIN 10% BS,11000,HCPCS,981,RC,,,,both,176.05,123.24,,,,,,,,,,,,,,,,,,,Other,28.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,55.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,28.24,55.64, CL TX FX GT PHALANX(S); W MANIP,28495,HCPCS,981,RC,,,,both,722.98,506.09,,,,,,,,,,,,,,,,,,,Other,169.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,184.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,169.04,184.05, ER REPAIR EXT. TENDON FINGER PRI/SEC,26418,HCPCS,450,RC,,,,both,9285.92,6500.14,,,,,,,,,,,,,,,,,,,Other,2002.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,592.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,592.05,2002.04, REP ET HAND; W FG EA TENDON,26412,HCPCS,981,RC,,,,both,3211.86,2248.3,,,,,,,,,,,,,,,,,,,Other,765.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,665.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,665.95,765.84, APPY PATELLAR TENDON BEARING CAST,29435,HCPCS,981,RC,,,,both,490.54,343.38,,,,,,,,,,,,,,,,,,,Other,93.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,133.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,93.16,133.01, CTRL POST EPISTAX SQ,30906,HCPCS,981,RC,,,,both,848.97,594.28,,,,,,,,,,,,,,,,,,,Other,141.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,380.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,141.04,380.25, UNLISTED PX NERVOUS SYSTEM,64999,HCPCS,981,RC,,,,both,404,282.8,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CL TX POST HIIP DISLOC WO ANESTH,27265,HCPCS,981,RC,,,,both,1028.18,719.73,,,,,,,,,,,,,,,,,,,Other,554.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,482.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,482.12,554.44, APPLICATION OF FINGER SPLING: DYNAMIC,29131,HCPCS,981,RC,,,,both,296,207.2,,,,,,,,,,,,,,,,,,,Other,35.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,56.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,35.69,56.44, STRAPPING HAND/FINGER,29280,HCPCS,981,RC,,,,both,145.9,102.13,,,,,,,,,,,,,,,,,,,Other,19.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,28.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.76,28.83, CL TX SHLDR DISL W MANIP W ANESTH,23655,HCPCS,981,RC,,,,both,1242.07,869.45,,,,,,,,,,,,,,,,,,,Other,471.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,409.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,409.68,471.14, REMOV FB INTRANASAL; RIGHT,30300,HCPCS,981,RC,,,,both,613.66,429.56,,,,,,,,,,,,,,,,,,,Other,126.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,196.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,126.3,196.79, INSERT BLADDER CATHETER,51701,HCPCS,981,RC,,,,both,217.26,152.08,,,,,,,,,,,,,,,,,,,Other,26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,43.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26,43.53, REM FB EXT AUDITORY CANAL; WO ANESTH,69200,HCPCS,450,RC,,,,both,399.98,279.99,,,,,,,,,,,,,,,,,,,Other,86.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,77.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,77.69,86.24, CL TX POST HIP DISLOC WO ANESTH,27265,HCPCS,450,RC,,,,both,802.35,561.65,,,,,,,,,,,,,,,,,,,Other,172.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,482.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,172.99,482.12, STRAPPING HAND/FINGER,29280,HCPCS,450,RC,,,,both,119.91,83.94,,,,,,,,,,,,,,,,,,,Other,25.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,28.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,25.85,28.83, CL TX SHLDR DISL W MANIP W ANESTH,23655,HCPCS,450,RC,,,,both,4974.49,3482.14,,,,,,,,,,,,,,,,,,,Other,1072.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,409.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,409.68,1072.5, STRAPPING ELBOW OR WRIST,29260,HCPCS,450,RC,,,,both,126.61,88.63,,,,,,,,,,,,,,,,,,,Other,27.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.2,27.29, STRAPPING ELBOW OR WRIST,29260,HCPCS,981,RC,,,,both,136.5,95.55,,,,,,,,,,,,,,,,,,,Other,17.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.88,27.2, DRAIN BL W/CATH INSERTION,51102,HCPCS,761,RC,,,,both,6415.4,4490.78,,,,,,,,,,,,,,,,,,,Other,1383.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,230.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,230.28,1383.16, THROMBOLYSIS CEREBRAL IV INFUSION,37195,HCPCS,450,RC,,,,both,1363,954.1,,,,,,,,,,,,,,,,,,,Other,293.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,293.86,293.86, ER PHYSICIAN LEVEL 1,99281,HCPCS,981,RC,,,,outpatient,254.02,177.81,,,,,,,,,,,,,,,,,,,Other,12.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.21,12.9, ER PHYSICIAN LEVEL 2,99282,HCPCS,981,RC,,,,outpatient,382,267.4,,,,,,,,,,,,,,,,,,,Other,47.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,41.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,41.15,47.32, ER PHYSICIAN LEVEL 3,99283,HCPCS,981,RC,,,,outpatient,764.01,534.81,,,,,,,,,,,,,,,,,,,Other,81.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,70.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,70.97,81.61, ER PHYSICIAN LEVEL 4,99284,HCPCS,981,RC,,,,outpatient,1200.73,840.51,,,,,,,,,,,,,,,,,,,Other,139.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,121.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,121.04,139.2, ER PHYSICIAN LEVEL 5,99285,HCPCS,981,RC,,,,outpatient,1931.52,1352.06,,,,,,,,,,,,,,,,,,,Other,201.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,174.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,174.91,201.14, ER PHYSICIAN CRITICAL CARE ADDL 30 MINS,99292,HCPCS,981,RC,,,,outpatient,882.23,617.56,,,,,,,,,,,,,,,,,,,Other,116.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,131.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,116.1,131.14, SYNVISC ONE INJ,J7325,HCPCS,636,RC,,1,EA,both,4371.07,3059.75,,,,,,,,,,,,,,,,,,,Other,942.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.41,942.41, SKIN SUBSTITUTE NOS- AMNIOFIX,J3590,HCPCS,636,RC,,,,both,2812.28,1968.6,,,,,,,,,,,,,,,,,,,Other,606.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,606.33,606.33, CL-EUFLEXXA INJ PER DOSE,J7323,HCPCS,636,RC,,1,EA,both,510,357,,,,,,,,,,,,,,,,,,,Other,109.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,103.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,103.35,109.96, HIP IM ROD OR PINNING,360,RC,,,,,,both,23147.19,16203.03,,,,,,,,,,,,,,,,,,,Other,4990.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4990.53,4990.53, ORTHOPEDICS I,360,RC,,,,,,both,125.98,88.19,,,,,,,,,,,,,,,,,,,Other,27.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,27.17,27.17, ORTHOPEDICS II,360,RC,,,,,,both,127.43,89.2,,,,,,,,,,,,,,,,,,,Other,27.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,27.47,27.47, ORTHOPEDICS III,360,RC,,,,,,both,148.23,103.76,,,,,,,,,,,,,,,,,,,Other,31.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,31.96,31.96, ORTHOPEDICS IV,360,RC,,,,,,both,152.34,106.64,,,,,,,,,,,,,,,,,,,Other,32.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.84,32.84, ORTHOPEDICS V,360,RC,,,,,,both,164.94,115.46,,,,,,,,,,,,,,,,,,,Other,35.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.56,35.56, ORTHOPEDICS MINOR PROCEDURE,360,RC,,,,,,both,2405.37,1683.76,,,,,,,,,,,,,,,,,,,Other,518.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,518.6,518.6, SYNVISC OR SYNVISC-ONE 1 MG,J7325,HCPCS,636,RC,,1,ME,both,121.99,85.39,,,,,,,,,,,,,,,,,,,Other,26.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.41,26.3, "DRAIN/INJ SMALL JOINT/BURSA W/O US BILAT,BILATERAL PROCEDURE",20600,HCPCS,360,RC,50,,,both,1474.47,1032.13,,,,,,,,,,,,,,,,,,,Other,317.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,80.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,80.6,317.89, TOT KNEE ARTHROPLASTY,360,RC,,,,,,both,43836.17,30685.32,,,,,,,,,,,,,,,,,,,Other,9451.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9451.08,9451.08, BIPOLAR OR TOT HIP REPLACEMENT,360,RC,,,,,,both,43836.17,30685.32,,,,,,,,,,,,,,,,,,,Other,9451.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9451.08,9451.08, KNEE ARTHROSCOPY,360,RC,,,,,,both,10542.07,7379.45,,,,,,,,,,,,,,,,,,,Other,2272.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2272.87,2272.87, ORTHO CARPAL TUNNEL,360,RC,,,,,,both,6423.12,4496.18,,,,,,,,,,,,,,,,,,,Other,1384.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1384.83,1384.83, TOT SHOULDER,360,RC,,,,,,both,45093.66,31565.56,,,,,,,,,,,,,,,,,,,Other,9722.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9722.2,9722.2, ROTATOR CUFF REPAIR & OTHER PROC,360,RC,,,,,,both,22942.13,16059.49,,,,,,,,,,,,,,,,,,,Other,4946.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4946.32,4946.32, NEUROPLASTY; ULNAR NERVE TRANSPOSITION-O,360,RC,,,,,,both,6423.14,4496.2,,,,,,,,,,,,,,,,,,,Other,1384.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1384.83,1384.83, KNEE MANIPULATION,360,RC,,,,,,both,4955.06,3468.54,,,,,,,,,,,,,,,,,,,Other,1068.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1068.31,1068.31, WRIST ORIF,360,RC,,,,,,both,22972.65,16080.86,,,,,,,,,,,,,,,,,,,Other,4952.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4952.9,4952.9, REVISION KNEE JOINT; 1 COMPONENT,360,RC,,,,,,both,21579.36,15105.55,,,,,,,,,,,,,,,,,,,Other,4652.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4652.51,4652.51, ANKLE ORIF,360,RC,,,,,,both,26724.64,18707.25,,,,,,,,,,,,,,,,,,,Other,5761.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5761.83,5761.83, CALCANEAL ORIF,360,RC,,,,,,both,21941.25,15358.88,,,,,,,,,,,,,,,,,,,Other,4730.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4730.54,4730.54, OPEN ROTATOR CUFF REPAIR,360,RC,,,,,,both,23095.6,16166.92,,,,,,,,,,,,,,,,,,,Other,4979.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4979.41,4979.41, ACL REPAIR,360,RC,,,,,,both,22678.38,15874.87,,,,,,,,,,,,,,,,,,,Other,4889.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4889.46,4889.46, OPEN TREATMENT METATARSAL FX,360,RC,,,,,,both,22678.38,15874.87,,,,,,,,,,,,,,,,,,,Other,4889.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4889.46,4889.46, REVISION OF HIP INTERNAL FIXATION,360,RC,,,,,,both,36888,25821.6,,,,,,,,,,,,,,,,,,,Other,7953.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7953.05,7953.05, REMOVAL INTERNAL FIXATION ULNA,360,RC,,,,,,both,9530.63,6671.44,,,,,,,,,,,,,,,,,,,Other,2054.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2054.81,2054.81, FUSION FINGER JOINT INITIAL JT,360,RC,,,,,,both,10804.55,7563.19,,,,,,,,,,,,,,,,,,,Other,2329.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2329.46,2329.46, ADD ON FUSION FINGER JOINT EACH ADDL JT,360,RC,,,,,,both,7090.11,4963.08,,,,,,,,,,,,,,,,,,,Other,1528.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1528.62,1528.62, SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRD,360,RC,,,,,,both,10804.55,7563.19,,,,,,,,,,,,,,,,,,,Other,2329.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2329.46,2329.46, ADD ON FUSION FINGER JOINT EACH ADDL JT,360,RC,,,,,,both,7090.11,4963.08,,,,,,,,,,,,,,,,,,,Other,1528.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1528.62,1528.62, OPTX FEM SHFT FX W/PLATE/SCREWS,360,RC,,,,,,both,26269.21,18388.45,,,,,,,,,,,,,,,,,,,Other,5663.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5663.65,5663.65, "BAG OSTOMY 1 3/4"" DRAINABLE",A4389,HCPCS,270,RC,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, SUTURE PROLENE 4-0 PC-5 ETH 8631G,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, SUTURE ETHILON 4-0 PC-5 ETH 1894G,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, DNO SUTURE ETHILON 5-0 PC-3 ETH 1965G,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, DNO SUTURE ETHILON 6-0 PC-1,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, DNO SUTURE CHROMIC 5-0 P-3 ETH 687G,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, DASH IT HALLOW DIRECT ACESS,272,RC,,,,,,both,1378.28,964.8,,,,,,,,,,,,,,,,,,,Other,297.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,297.16,297.16, "DNO SUTURE PROLENE 6-0 BV-1 30"" 8709H",272,RC,,,,,,both,89.22,62.45,,,,,,,,,,,,,,,,,,,Other,19.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.24,19.24, FROVA INTUBATING INTRODUCER 8F,272,RC,,,,,,both,340.2,238.14,,,,,,,,,,,,,,,,,,,Other,73.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,73.34,73.34, RAPI-FIT FROVA INTUBATING INTRODUCER 14F,272,RC,,,,,,both,326.6,228.62,,,,,,,,,,,,,,,,,,,Other,70.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,70.41,70.41, RAPID-FIT FROVA INTUBATING INTRODUCER 14,272,RC,,,,,,both,276.67,193.67,,,,,,,,,,,,,,,,,,,Other,59.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,59.65,59.65, RETOGRADE INTUBATION SET 11F,272,RC,,,,,,both,570.22,399.15,,,,,,,,,,,,,,,,,,,Other,122.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,122.94,122.94, RETROGRADE INTUBATION SET REPLACEMENT WI,272,RC,,,,,,both,204.21,142.95,,,,,,,,,,,,,,,,,,,Other,44.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.03,44.03, SUTURE GORTEX 2-0 CV-2 2N08A,272,RC,,,,,,both,79.81,55.87,,,,,,,,,,,,,,,,,,,Other,17.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.21,17.21, CONV SUTURE VICRYL 4-0 RB-1 ETH J214H,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, CONV SUTURE VICRYL 3-0 BRAIDED VCP110G,272,RC,,,,,,both,43.67,30.57,,,,,,,,,,,,,,,,,,,Other,9.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.42,9.42, SOFT TIPPED AIRWAY EXCHANGE CATHETER 11F,272,RC,,,,,,both,224.25,156.98,,,,,,,,,,,,,,,,,,,Other,48.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,48.35,48.35, CONV SUTURE CHROMIC 3-0 SH ETH G122H,272,RC,,,,,,both,23.05,16.14,,,,,,,,,,,,,,,,,,,Other,4.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.97,4.97, CONV SUTURE MONOCRYL 4-0 PS-2 ETH Y426H,272,RC,,,,,,both,30.26,21.18,,,,,,,,,,,,,,,,,,,Other,6.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.53,6.53, ENK OXYGEN FLOW MODULATOR SET 6F,272,RC,,,,,,both,494.74,346.32,,,,,,,,,,,,,,,,,,,Other,106.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,106.66,106.66, "CONV SUTURE SILK 2-0 18"" TIE ETH A185H",272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, SUTURE RETENTION BRIDGES ETH RSB5,272,RC,,,,,,both,37.29,26.1,,,,,,,,,,,,,,,,,,,Other,8.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.04,8.04, CONV SUTURE PROLENE 4-0 RB-1 ETH 8557H,272,RC,,,,,,both,20.6,14.42,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.44,4.44, CATH SILICONE 16FR 5CC,A4344,HCPCS,272,RC,,,,both,26.99,18.89,,,,,,,,,,,,,,,,,,,Other,5.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.82,5.82, DNO SUTURE PROLENE 5-0 C-1 ETH 8720H,272,RC,,,,,,both,65.89,46.12,,,,,,,,,,,,,,,,,,,Other,14.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.21,14.21, CATH SILICONE 18FR 10CC,A4344,HCPCS,272,RC,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, CATH SILICONE 24FR 5CC,A4344,HCPCS,272,RC,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, SUTURE PROLENE 5-0 P-3 ETH 8698G,272,RC,,,,,,both,20.6,14.42,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.44,4.44, SUTURE SILK 2-0 K-S ETH 623H,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, DNO SUTURE ETHILON 6-0 C-2 ETH 667G,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, DNO SUTURE ETHILON 2-0 ETH 664G,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, CONV SUTURE ETHILON 3-0 FS-1 ETH 663H,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, SUTURE ETHILON 4-0 FS-2 ETH 662G,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, DNO SUTURE ETHILON 6-0 PS-3 ETH 1665G,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, CONV SUTURE ETHILON 4-0 FS-2 ETH 662H,272,RC,,,,,,both,20.6,14.42,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.44,4.44, SUTURE PROLENE #1 TP-1 LOOPED ETH D9487,272,RC,,,,,,both,169.16,118.41,,,,,,,,,,,,,,,,,,,Other,36.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.48,36.48, SUTURE PROLENE MONO BLUE 1.60 TP-1 ETH 8,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, SUTURE PDS #1 TP-1 LOOPED ETH Z880G,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, SUTURE PROLENE 0 SH ETH 8834H,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, POWDER PREMIUM (OSTOMY CARE),A4371,HCPCS,270,RC,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, "DNO SUTURE SILK 3-0 18"" TIES ETH A-184H",272,RC,,,,,,both,22.05,15.44,,,,,,,,,,,,,,,,,,,Other,4.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.75,4.75, "SUTURE SILK 3-0 30"" TIES ETH A304H",272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, "SUTURE 3-0 SURGIPRO C-13 18""",272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, CONV SUTURE SILK 2-0 FS ETH 685-G,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, CONV SUTURE ETHILON 3-0 FS-1 ETH 663G,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, SUTURE PROLENE #1 CT-X ETH 8455-H,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, SUTURE PROLENE 0 V-34 ETH 8444H,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, DNO SUTURE PROLENE 3-0 FS-2 ETH 8665G,272,RC,,,,,,both,20.6,14.42,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.44,4.44, SUTURE PROLENE 7-0 P-6 ETH 8648G,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, "CONV SUTURE SILK 2-0 SH 30"" ETH K833H",272,RC,,,,,,both,20.6,14.42,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.44,4.44, PATENCY CAPSULE,272,RC,,,,,,both,133.63,93.54,,,,,,,,,,,,,,,,,,,Other,28.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28.81,28.81, CATH MALECOT 26FR,272,RC,,,,,,both,108.58,76.01,,,,,,,,,,,,,,,,,,,Other,23.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.41,23.41, CONV SUTURE PDS #1 TP-1 ETH Z879G,272,RC,,,,,,both,23.21,16.25,,,,,,,,,,,,,,,,,,,Other,5.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.01,5.01, SUTURE PDS 4-0 RB-1 ETH Z304H,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, CONV SUTURE PDS 0 CT-2 ETH Z334H,272,RC,,,,,,both,20.6,14.42,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.44,4.44, DNO SUTURE PDS 2-0 CT-1 ETH Z339H,272,RC,,,,,,both,22.07,15.45,,,,,,,,,,,,,,,,,,,Other,4.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.76,4.76, CONV SUTURE PDS 3-0 SH ETH Z316H,272,RC,,,,,,both,20.6,14.42,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.44,4.44, SUTURE PDS 2-0 SH ETH Z317H,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, SUTURE PDS 5-0 II P-3 ETH Z493G,272,RC,,,,,,both,26.05,18.24,,,,,,,,,,,,,,,,,,,Other,5.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.62,5.62, SUTURE CHROMIC 2-0 CT-3 ETH 893H,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, SUTURE PROLENE 6-0 P-1 ETH 8697G,272,RC,,,,,,both,21.19,14.83,,,,,,,,,,,,,,,,,,,Other,4.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.57,4.57, SUTURE CHROMIC 3-0 RB-1 ETHU204H,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, DNO SUTURE SILK 2-0 SH CR/8 ETH C012D,272,RC,,,,,,both,31.13,21.79,,,,,,,,,,,,,,,,,,,Other,6.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.71,6.71, SUTURE SILK 3-0 SH CR/8 ETH C013D,272,RC,,,,,,both,45.05,31.54,,,,,,,,,,,,,,,,,,,Other,9.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.71,9.71, "SUTURE SILK 3-0 SH 30"" CR/8 C017T",272,RC,,,,,,both,34.51,24.16,,,,,,,,,,,,,,,,,,,Other,7.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.44,7.44, "SUTURE SILK 4-0 30"" TIES ETH SA83H",272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, CONV SUTURE VICRYL 2-0 CT1 CR8 J839D,272,RC,,,,,,both,57.62,40.33,,,,,,,,,,,,,,,,,,,Other,12.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.43,12.43, "SUTURE SILK 4-0 30"" TIES ETH A303H",272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, CONV SUTURE MONOCRYL 3-0 PS-1 ETH Y936H,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, DNO SUTURE MONOCRYL 2-0 ETH Y945H,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, SUTURE MONOCRYL 3-0 PS-2 ETH Y497G,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, CATH FOGARTY BILRY 5F,272,RC,,,,,,both,366.53,256.57,,,,,,,,,,,,,,,,,,,Other,79.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,79.03,79.03, CATH 7.5FR TAUT CHOLANGOGRAM,272,RC,,,,,,both,162.05,113.44,,,,,,,,,,,,,,,,,,,Other,34.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.94,34.94, STETHOSCOPE ESOPHAGEAL 18FR,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, GELPORT LAPAROSCOPIC SYSTEM,272,RC,,,,,,both,2081.25,1456.88,,,,,,,,,,,,,,,,,,,Other,448.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.72,448.72, CATH THORACIC 16FR STRAIGHT,272,RC,,,,,,both,33.93,23.75,,,,,,,,,,,,,,,,,,,Other,7.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.31,7.31, CATH THORACIC 20FR,272,RC,,,,,,both,32.68,22.88,,,,,,,,,,,,,,,,,,,Other,7.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.05,7.05, BRUSH CYTOLOGY DISPOSABLE,272,RC,,,,,,both,145.29,101.7,,,,,,,,,,,,,,,,,,,Other,31.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,31.32,31.32, NEEDLE INTRAOSSEOUS 15G 25MM 40KGS,272,RC,,,,,,both,468.53,327.97,,,,,,,,,,,,,,,,,,,Other,101.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,101.02,101.02, NEEDLE INTRAOSSEOUS 15G 15MM 3-39KGS,272,RC,,,,,,both,491.27,343.89,,,,,,,,,,,,,,,,,,,Other,105.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,105.92,105.92, NEEDLE INTRAOSSEOUS 15G 45MM BAR,272,RC,,,,,,both,491.27,343.89,,,,,,,,,,,,,,,,,,,Other,105.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,105.92,105.92, DNO EZ-STABILIZER,272,RC,,,,,,both,80.16,56.11,,,,,,,,,,,,,,,,,,,Other,17.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.29,17.29, GRAFT BIFURCATED 16 X,C1768,HCPCS,278,RC,,,,both,1511.71,1058.2,,,,,,,,,,,,,,,,,,,Other,325.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,325.93,325.93, GRAFT AAA BIFURCATED MAIN BODY,C1768,HCPCS,278,RC,,,,both,26015.4,18210.78,,,,,,,,,,,,,,,,,,,Other,5608.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5608.92,5608.92, GRAFT AAA ILIAC LEG GRAFT,C1768,HCPCS,278,RC,,,,both,9492.1,6644.47,,,,,,,,,,,,,,,,,,,Other,2046.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2046.49,2046.49, GRAFT AAA ILIAC LEG GRAFT,C1768,HCPCS,278,RC,,,,both,9492.1,6644.47,,,,,,,,,,,,,,,,,,,Other,2046.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2046.49,2046.49, GRAFT,278,RC,,,,,,both,1899.22,1329.45,,,,,,,,,,,,,,,,,,,Other,409.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,409.47,409.47, GRAFT HEMASHIELD GOLD 20MMX10MMXL40CM,C1768,HCPCS,278,RC,,,,both,2404.46,1683.12,,,,,,,,,,,,,,,,,,,Other,518.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,518.4,518.4, GRAFT HEMASHIELD GOLD 22MMX11MMXL40CM,C1768,HCPCS,278,RC,,,,both,2812.48,1968.74,,,,,,,,,,,,,,,,,,,Other,606.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,606.38,606.38, CONV SUTURE VICRYL 4-0 TF ETH J434H,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, "DRESSING 4 X 4"" AG MEPILEX ADHESIVE",272,RC,,,,,,both,26.9,18.83,,,,,,,,,,,,,,,,,,,Other,5.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.8,5.8, DNO DRESSING HYDROFERA BLUE W/FILM 4X4,272,RC,,,,,,both,27.91,19.54,,,,,,,,,,,,,,,,,,,Other,6.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.02,6.02, WIPE INSTRUMENT-MENTR,272,RC,,,,,,both,34.44,24.11,,,,,,,,,,,,,,,,,,,Other,7.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.43,7.43, MEDIHONEY 1.5OZ TUBE,271,RC,,,,1,ML,both,51.81,36.27,,,,,,,,,,,,,,,,,,,Other,11.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.17,11.17, MEDIFIL PARTICLES COLLAGEN 1GR,A6262,HCPCS,272,RC,,,,both,73.55,51.49,,,,,,,,,,,,,,,,,,,Other,15.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.86,15.86, MESH FLAT SHEET 6X6,C1781,HCPCS,278,RC,,,,both,377.29,264.1,,,,,,,,,,,,,,,,,,,Other,81.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.34,81.34, PHASIX PLUG AND PATCH,C1781,HCPCS,278,RC,,,,both,579.99,405.99,,,,,,,,,,,,,,,,,,,Other,125.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,125.05,125.05, PROLENE HERNIA SYSTEM MESH,C1781,HCPCS,278,RC,,,,both,861.44,603.01,,,,,,,,,,,,,,,,,,,Other,185.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,185.73,185.73, PHASIX MESH 3x4,C1781,HCPCS,278,RC,,,,both,7189.39,5032.57,,,,,,,,,,,,,,,,,,,Other,1550.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1550.04,1550.04, DNO SUTURE ETHILON 5-0 P-3 ETH 698-G,272,RC,,,,,,both,20.6,14.42,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.44,4.44, CATH FOGARTY ART EMB 4FR 80 LATEX FREE,C1757,HCPCS,278,RC,,,,both,195.71,137,,,,,,,,,,,,,,,,,,,Other,42.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.2,42.2, CATH FOGARTY ART EMB 3 FR LATEX FREE,C1757,HCPCS,278,RC,,,,both,196.75,137.73,,,,,,,,,,,,,,,,,,,Other,42.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.42,42.42, CATH ART EMB 3 FR,C1757,HCPCS,272,RC,,,,both,207.99,145.59,,,,,,,,,,,,,,,,,,,Other,44.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.84,44.84, CATH ANGIOGRAPHIC 4FR BERN 65CM,C1757,HCPCS,272,RC,,,,both,57.65,40.36,,,,,,,,,,,,,,,,,,,Other,12.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.43,12.43, CATH ART EMB 4FR 80,C1757,HCPCS,272,RC,,,,both,222.61,155.83,,,,,,,,,,,,,,,,,,,Other,47.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.99,47.99, PHASIX MESH 4x6,C1781,HCPCS,278,RC,,,,both,9632.72,6742.9,,,,,,,,,,,,,,,,,,,Other,2076.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2076.82,2076.82, DNO CATH ART EMBOLECTOMY 5FR,C1757,HCPCS,278,RC,,,,both,207.99,145.59,,,,,,,,,,,,,,,,,,,Other,44.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.84,44.84, MESH PROLENE 3.0 X 6.,C1781,HCPCS,278,RC,,,,both,395.82,277.07,,,,,,,,,,,,,,,,,,,Other,85.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,85.34,85.34, MESH PROLENE 12 X 12,C1781,HCPCS,278,RC,,,,both,412.91,289.04,,,,,,,,,,,,,,,,,,,Other,89.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,89.02,89.02, PHASIX MESH 6X8,C1781,HCPCS,278,RC,,,,both,15820.17,11074.12,,,,,,,,,,,,,,,,,,,Other,3410.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3410.83,3410.83, DNO DRESSING AQUACEL AG 4 X 5,272,RC,,,,,,both,31.17,21.82,,,,,,,,,,,,,,,,,,,Other,6.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.72,6.72, GRAFT PTFE BIFURCATED 18X9X40,C1768,HCPCS,278,RC,,,,both,3487.94,2441.56,,,,,,,,,,,,,,,,,,,Other,752,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,752,752, GRAFT PTFE BIFURCATED 20X10X40,C1768,HCPCS,278,RC,,,,both,1765.3,1235.71,,,,,,,,,,,,,,,,,,,Other,380.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,380.6,380.6, PHASIX MESH 8x10,C1781,HCPCS,278,RC,,,,both,26718.52,18702.96,,,,,,,,,,,,,,,,,,,Other,5760.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5760.51,5760.51, GRAFT THIN WALL 8MMX60CM,C1768,HCPCS,278,RC,,,,both,4369.89,3058.92,,,,,,,,,,,,,,,,,,,Other,942.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,942.15,942.15, T-ANCHORS HERNIA SET,272,RC,,,,,,both,231.44,162.01,,,,,,,,,,,,,,,,,,,Other,49.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,49.9,49.9, SURGIMESH XB,C1781,HCPCS,278,RC,,,,both,5800.73,4060.51,,,,,,,,,,,,,,,,,,,Other,1250.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1250.64,1250.64, CATH ART EMB,C1757,HCPCS,278,RC,,,,both,195.71,137,,,,,,,,,,,,,,,,,,,Other,42.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.2,42.2, GRAFT VASC 6MM 40CM,C1768,HCPCS,278,RC,,,,both,2594.51,1816.16,,,,,,,,,,,,,,,,,,,Other,559.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,559.37,559.37, GRAFT VASC 4MM-7MM THIN-WALLED,C1768,HCPCS,278,RC,,,,both,5990.57,4193.4,,,,,,,,,,,,,,,,,,,Other,1291.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1291.57,1291.57, GRAFT RINGED 6 X 90,C1768,HCPCS,278,RC,,,,both,4805.82,3364.07,,,,,,,,,,,,,,,,,,,Other,1036.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1036.13,1036.13, HEMORRHOID LIGATOR 13-15MM STIEGMAN GOFF,278,RC,,,,,,both,217.13,151.99,,,,,,,,,,,,,,,,,,,Other,46.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,46.81,46.81, PHASIX MESH 10x12,C1781,HCPCS,278,RC,,,,both,51749.55,36224.69,,,,,,,,,,,,,,,,,,,Other,11157.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11157.2,11157.2, GRAFT VASC 14MMX7MM 40 CM,C1768,HCPCS,278,RC,,,,both,3282.41,2297.69,,,,,,,,,,,,,,,,,,,Other,707.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,707.69,707.69, GRAFT VASC 12MMX6MM 40 CM,C1768,HCPCS,278,RC,,,,both,2524.19,1766.93,,,,,,,,,,,,,,,,,,,Other,544.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,544.21,544.21, GRAFT HEMASHIELD GOLD 18X9X40,C1768,HCPCS,278,RC,,,,both,2360.9,1652.63,,,,,,,,,,,,,,,,,,,Other,509.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,509.01,509.01, GRAFT HEMASHIELD GOLD,C1768,HCPCS,278,RC,,,,both,2812.48,1968.74,,,,,,,,,,,,,,,,,,,Other,606.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,606.38,606.38, PHASIX MESH 15CMX20CM,C1781,HCPCS,278,RC,,,,both,27175.54,19022.88,,,,,,,,,,,,,,,,,,,Other,5859.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5859.05,5859.05, GRAFT RINGED 6 X 40,C1768,HCPCS,278,RC,,,,both,2462.67,1723.87,,,,,,,,,,,,,,,,,,,Other,530.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,530.95,530.95, MESH PARIETEX VENTRAL PATCH 6CM,C1781,HCPCS,278,RC,,,,both,1375.62,962.93,,,,,,,,,,,,,,,,,,,Other,296.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,296.59,296.59, GRAFT VASC 8MM 80CM,C1768,HCPCS,278,RC,,,,both,5494.87,3846.41,,,,,,,,,,,,,,,,,,,Other,1184.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1184.69,1184.69, DNO GRAFT VASC 6-4.5X80CM DISTAFLOW,C1768,HCPCS,278,RC,,,,both,8525.32,5967.72,,,,,,,,,,,,,,,,,,,Other,1838.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1838.06,1838.06, GRAFT VASC 6MMX80CM FLEX SM W/STAND,C1768,HCPCS,278,RC,,,,both,6806.19,4764.33,,,,,,,,,,,,,,,,,,,Other,1467.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1467.41,1467.41, GRAFT THIN WALL 6MMX60CM PTFE,C1768,HCPCS,278,RC,,,,both,4369.89,3058.92,,,,,,,,,,,,,,,,,,,Other,942.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,942.15,942.15, GRAFT DERMAL & EPIDERMAL TISSUE,C1768,HCPCS,278,RC,,,,both,6855.4,4798.78,,,,,,,,,,,,,,,,,,,Other,1478.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1478.03,1478.03, VASCULAR GRAFT 35 CM,C1768,HCPCS,278,RC,,,,both,5058.95,3541.27,,,,,,,,,,,,,,,,,,,Other,1090.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1090.71,1090.71, DERMIS AXIS 6X8 CM,C1768,HCPCS,278,RC,,,,both,6011.67,4208.17,,,,,,,,,,,,,,,,,,,Other,1296.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1296.12,1296.12, VASCULAR GRAFT,C1768,HCPCS,278,RC,,,,both,4682.77,3277.94,,,,,,,,,,,,,,,,,,,Other,1009.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1009.61,1009.61, GRAFT VASC 6MMX40CM,C1768,HCPCS,278,RC,,,,both,3691.38,2583.97,,,,,,,,,,,,,,,,,,,Other,795.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,795.86,795.86, GRAFT VASC 8MMX80CM,C1768,HCPCS,278,RC,,,,both,7031.19,4921.83,,,,,,,,,,,,,,,,,,,Other,1515.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1515.92,1515.92, GRAFT VASC 6MMX80CM,C1768,HCPCS,278,RC,,,,both,8296.8,5807.76,,,,,,,,,,,,,,,,,,,Other,1788.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1788.79,1788.79, GRAFT VASC 8MMX80CM,C1768,HCPCS,278,RC,,,,both,8384.69,5869.28,,,,,,,,,,,,,,,,,,,Other,1807.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1807.74,1807.74, GRAFT VASC 4MMX7MMTAPEREDX45CM,C1768,HCPCS,278,RC,,,,both,4229.26,2960.48,,,,,,,,,,,,,,,,,,,Other,911.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,911.83,911.83, GRAFT VASC 8MM-100CM THIN-WALLED,C1768,HCPCS,278,RC,,,,both,6277.05,4393.94,,,,,,,,,,,,,,,,,,,Other,1353.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1353.33,1353.33, GRAFT 4.5MM-6.5MMX70CM THIN WALLED,C1768,HCPCS,278,RC,,,,both,3012.86,2109,,,,,,,,,,,,,,,,,,,Other,649.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,649.57,649.57, STENT GUIDE LEMAITRE,C1874,HCPCS,278,RC,,,,both,205.28,143.7,,,,,,,,,,,,,,,,,,,Other,44.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.26,44.26, GRAFT VASC 8MM-58CM THIN-WALLED,C1768,HCPCS,278,RC,,,,both,2870.97,2009.68,,,,,,,,,,,,,,,,,,,Other,618.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,618.98,618.98, GRAFT VASC 8MM-42CM THIN-WALLED,C1768,HCPCS,278,RC,,,,both,2078.98,1455.29,,,,,,,,,,,,,,,,,,,Other,448.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.23,448.23, STAPLER ROTCUL55-4.8,272,RC,,,,,,both,969.21,678.45,,,,,,,,,,,,,,,,,,,Other,208.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,208.97,208.97, PAPILLOTOME COTTON DOUBLE LUMEN,272,RC,,,,,,both,564.96,395.47,,,,,,,,,,,,,,,,,,,Other,121.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,121.8,121.8, GUIDE WIRE 7.5 35-480,C1769,HCPCS,278,RC,,,,both,365.62,255.93,,,,,,,,,,,,,,,,,,,Other,78.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,78.83,78.83, "DRESSING AG EXUFIBER 4 X 4.8""",272,RC,,,,,,both,23.7,16.59,,,,,,,,,,,,,,,,,,,Other,5.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.11,5.11, NEEDLE SPINAL 20GX3.54MONO,272,RC,,,,,,both,21,14.7,,,,,,,,,,,,,,,,,,,Other,4.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.53,4.53, SUTURE DEXON PRE-1 ETH 9532-215-0,272,RC,,,,,,both,31.58,22.11,,,,,,,,,,,,,,,,,,,Other,6.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.81,6.81, SUTURE SILK 3-0 PS-1 ETH 1684G,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, NEBULIZER VORTRAN PERCUSSIVE,271,RC,,,,,,both,427.53,299.27,,,,,,,,,,,,,,,,,,,Other,92.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,92.18,92.18, EXERCISER VOLUMETRIC 4000ML,270,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, AQUA-PACK 1000 ML,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, LINE PRESSURE MONITOR,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, SUTURE PDS 0 CT-1 ETH Z346H,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, S-CURVE URETHRAL DILATOR SET W/ AQ HYDRO,272,RC,,,,,,both,1283.72,898.6,,,,,,,,,,,,,,,,,,,Other,276.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,276.77,276.77, GUIDE WIRE PC ROADRUNNER,C1769,HCPCS,278,RC,,,,both,211.02,147.71,,,,,,,,,,,,,,,,,,,Other,45.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,45.49,45.49, CYSTIC DUCT INTRODUCER,272,RC,,,,,,both,338.25,236.78,,,,,,,,,,,,,,,,,,,Other,72.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,72.93,72.93, S-CURVE URETHRAL DILATOR 22 FR,272,RC,,,,,,both,172.42,120.69,,,,,,,,,,,,,,,,,,,Other,37.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.17,37.17, CONV SUTURE VICRYL 2-0 SH ETH J417H,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, GUIDE WIRE ROADRUNNER .018 300CM,C1769,HCPCS,278,RC,,,,both,580.08,406.06,,,,,,,,,,,,,,,,,,,Other,125.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,125.07,125.07, GRAFT PRE SHAPED,278,RC,,,,,,both,3255.78,2279.05,,,,,,,,,,,,,,,,,,,Other,701.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,701.94,701.94, GRAFT STRAIGHT 6MMX60CM REMV RING THIN W,C1768,HCPCS,278,RC,,,,both,4120.28,2884.2,,,,,,,,,,,,,,,,,,,Other,888.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,888.33,888.33, GRAFT STRAIGHT 8MMX80CM PTFE REM RING TH,C1768,HCPCS,278,RC,,,,both,4630.04,3241.03,,,,,,,,,,,,,,,,,,,Other,998.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,998.24,998.24, GRAFT DISTA FLOW SM CUFF 80CMX6M,C1768,HCPCS,278,RC,,,,both,6806.19,4764.33,,,,,,,,,,,,,,,,,,,Other,1467.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1467.41,1467.41, STENT ICAST 8MMX38MMX80CM,C1874,HCPCS,278,RC,,,,both,8831.86,6182.3,,,,,,,,,,,,,,,,,,,Other,1904.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1904.15,1904.15, STENT ICAST 6MMX59MMX80CM,C1874,HCPCS,278,RC,,,,both,9517.83,6662.48,,,,,,,,,,,,,,,,,,,Other,2052.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2052.04,2052.04, STENT ICAST 10MMX38MMX80CM,C1874,HCPCS,278,RC,,,,both,8831.86,6182.3,,,,,,,,,,,,,,,,,,,Other,1904.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1904.15,1904.15, STENT TACSHIELD 3X6,C1874,HCPCS,278,RC,,,,both,1680.63,1176.44,,,,,,,,,,,,,,,,,,,Other,362.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,362.35,362.35, STENT TACSHIELD 4X6,C1874,HCPCS,278,RC,,,,both,1817.82,1272.47,,,,,,,,,,,,,,,,,,,Other,391.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,391.92,391.92, STENT TACSHIELD 5X5,C1874,HCPCS,278,RC,,,,both,1817.82,1272.47,,,,,,,,,,,,,,,,,,,Other,391.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,391.92,391.92, STENT TACSHIELD 6X8,C1874,HCPCS,278,RC,,,,both,2929.09,2050.36,,,,,,,,,,,,,,,,,,,Other,631.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,631.51,631.51, STENT TACSHIELD 8X10,C1874,HCPCS,278,RC,,,,both,4784.64,3349.25,,,,,,,,,,,,,,,,,,,Other,1031.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1031.57,1031.57, STENT TACSHIELD 8X12,C1874,HCPCS,278,RC,,,,both,5247.66,3673.36,,,,,,,,,,,,,,,,,,,Other,1131.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1131.4,1131.4, US CBL EXTNS DISPOSABLE,272,RC,,,,,,both,102.9,72.03,,,,,,,,,,,,,,,,,,,Other,22.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.19,22.19, WRENCH KIT ASSEM-BLY KIT,272,RC,,,,,,both,155.9,109.13,,,,,,,,,,,,,,,,,,,Other,33.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,33.61,33.61, DNO VALVE-HEIMLICH,272,RC,,,,,,both,138.08,96.66,,,,,,,,,,,,,,,,,,,Other,29.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,29.77,29.77, CONV SUTURE VICRYL 5-0 TF ETH J433H,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, CATH ART EMB 7.5 FR,C1757,HCPCS,272,RC,,,,both,351.56,246.09,,,,,,,,,,,,,,,,,,,Other,75.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,75.79,75.79, CATH ENDOBRONCHO 41FR LEFT,272,RC,,,,,,both,166.9,116.83,,,,,,,,,,,,,,,,,,,Other,35.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.99,35.99, CATH ENDOBRONCHO 39F LEFT,272,RC,,,,,,both,202.5,141.75,,,,,,,,,,,,,,,,,,,Other,43.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.66,43.66, CATH BRONCHO 39FR RIG,272,RC,,,,,,both,193.73,135.61,,,,,,,,,,,,,,,,,,,Other,41.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.77,41.77, BRONCHOSCOPE ASCOPE 4 SAMPLER 5MM/2.2MM,272,RC,,,,,,both,875.79,613.05,,,,,,,,,,,,,,,,,,,Other,188.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,188.82,188.82, CATH ENDOBRONCHO 37FR RIGHT,272,RC,,,,,,both,189.2,132.44,,,,,,,,,,,,,,,,,,,Other,40.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.79,40.79, CATH ENDOBRONCHO 37FR LEFT,272,RC,,,,,,both,166.9,116.83,,,,,,,,,,,,,,,,,,,Other,35.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.99,35.99, CATH HEMO 20FR 30CC,C1757,HCPCS,278,RC,,,,both,21.11,14.78,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO CATH SILICONE 20FR 30CC BALLOON,272,RC,,,,,,both,52.56,36.79,,,,,,,,,,,,,,,,,,,Other,11.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.33,11.33, SUTURE ETHILON 5-0 PC-5 ETH 1895G,272,RC,,,,,,both,23.56,16.49,,,,,,,,,,,,,,,,,,,Other,5.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.08,5.08, CATH THORACIC 24FR,272,RC,,,,,,both,35.62,24.93,,,,,,,,,,,,,,,,,,,Other,7.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.68,7.68, CATH THORACIC STRAIGHT 28FR,272,RC,,,,,,both,23.97,16.78,,,,,,,,,,,,,,,,,,,Other,5.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.16,5.16, CATH THORACIC 36FR x 20 STRAIGHT,272,RC,,,,,,both,31.12,21.78,,,,,,,,,,,,,,,,,,,Other,6.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.71,6.71, CATH THORACIC 32FR STRAIGHT,272,RC,,,,,,both,39.59,27.71,,,,,,,,,,,,,,,,,,,Other,8.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.54,8.54, CATH THORACIC 36FR RIGHT ANGLE,272,RC,,,,,,both,44.36,31.05,,,,,,,,,,,,,,,,,,,Other,9.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.56,9.56, CATH SPIROFLEX 4F 135CM,C1725,HCPCS,278,RC,,,,both,5470.61,3829.43,,,,,,,,,,,,,,,,,,,Other,1179.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1179.46,1179.46, CATH SPIROFLEX 5F 135CM,C1725,HCPCS,278,RC,,,,both,5470.61,3829.43,,,,,,,,,,,,,,,,,,,Other,1179.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1179.46,1179.46, CATH SPIROFLEX 6F 120CM,C1725,HCPCS,278,RC,,,,both,6619.6,4633.72,,,,,,,,,,,,,,,,,,,Other,1427.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1427.18,1427.18, CATH SPIROFLEX 6F 90CM,C1725,HCPCS,278,RC,,,,both,7991.54,5594.08,,,,,,,,,,,,,,,,,,,Other,1722.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1722.98,1722.98, CATH SPIROFLEX 6F 50CM,C1725,HCPCS,278,RC,,,,both,3086.86,2160.8,,,,,,,,,,,,,,,,,,,Other,665.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,665.53,665.53, "DNO CATH, DUAL LUMEN URETHERAL",C1758,HCPCS,272,RC,,,,both,417.49,292.24,,,,,,,,,,,,,,,,,,,Other,90.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,90.01,90.01, DILATOR 8/10 SHEATH SET,C1894,HCPCS,278,RC,,,,both,177.32,124.12,,,,,,,,,,,,,,,,,,,Other,38.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,38.23,38.23, CATH COUNCIL 22FR 5CC,272,RC,,,,,,both,51.1,35.77,,,,,,,,,,,,,,,,,,,Other,11.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.02,11.02, CATH COUNCIL TIP 18FR 5CC,A4330,HCPCS,272,RC,,,,both,79.52,55.66,,,,,,,,,,,,,,,,,,,Other,17.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.14,17.14, CATH COUNCIL TIP 20FR 5CC,A4330,HCPCS,272,RC,,,,both,54.06,37.84,,,,,,,,,,,,,,,,,,,Other,11.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.65,11.65, DILATOR NAVIGATION 12/14FR,C1894,HCPCS,272,RC,,,,both,694.04,485.83,,,,,,,,,,,,,,,,,,,Other,149.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,149.64,149.64, CATH FLEXIMA ALL PURPOSE 6X20,272,RC,,,,,,both,209.09,146.36,,,,,,,,,,,,,,,,,,,Other,45.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,45.08,45.08, CATH FLEXIMA APD J TIP 8X20,272,RC,,,,,,both,209.09,146.36,,,,,,,,,,,,,,,,,,,Other,45.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,45.08,45.08, BRUSH CYTOLOGY 3.0/85,272,RC,,,,,,both,63.89,44.72,,,,,,,,,,,,,,,,,,,Other,13.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.78,13.78, PLEURX PERITONEAL CATH KIT,271,RC,,,,,,both,2080.13,1456.09,,,,,,,,,,,,,,,,,,,Other,448.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.48,448.48, "PERITX PERITONEAL CATH KIT 15.5, 71CM",271,RC,,,,,,both,3996,2797.2,,,,,,,,,,,,,,,,,,,Other,861.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,861.54,861.54, *CATH ALL PURPOSE 20FR,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, PLEURX DRAINAGE SYSTEM 1000ML,271,RC,,,,,,both,213.44,149.41,,,,,,,,,,,,,,,,,,,Other,46.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,46.02,46.02, TUBE GASTRONOMY 16FR 20CC,272,RC,,,,,,both,341.28,238.9,,,,,,,,,,,,,,,,,,,Other,73.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,73.58,73.58, MOSS G-TUBE PEG KIT 18FR,272,RC,,,,,,both,1853.24,1297.27,,,,,,,,,,,,,,,,,,,Other,399.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,399.56,399.56, MOSS TUBE GASTROSTOMY 18FR,272,RC,,,,,,both,915.75,641.03,,,,,,,,,,,,,,,,,,,Other,197.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,197.44,197.44, TUBE GASTRONOMY 18FR 20CC,272,RC,,,,,,both,341.28,238.9,,,,,,,,,,,,,,,,,,,Other,73.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,73.58,73.58, TUBE GASTRONOMY 22FR 20CC,272,RC,,,,,,both,199.05,139.34,,,,,,,,,,,,,,,,,,,Other,42.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.91,42.91, TUBE GASTROSTOMY 20FR 20CC,272,RC,,,,,,both,245.99,172.19,,,,,,,,,,,,,,,,,,,Other,53.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,53.04,53.04, DNO MEASURING STOMA DEVICE,272,RC,,,,,,both,21.88,15.32,,,,,,,,,,,,,,,,,,,Other,4.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.71,4.71, TRAY INTRODUCER 9 FR,272,RC,,,,,,both,198.03,138.62,,,,,,,,,,,,,,,,,,,Other,42.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.7,42.7, KIT BUTTON REPLACEMENT 18FR,272,RC,,,,,,both,1014.25,709.98,,,,,,,,,,,,,,,,,,,Other,218.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,218.68,218.68, KIT BUTTON REPLACEMENT 18FR X 2.4CM,272,RC,,,,,,both,1341.31,938.92,,,,,,,,,,,,,,,,,,,Other,289.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,289.19,289.19, KIT BUTTON REPLACEMENT 18FR,272,RC,,,,,,both,405.16,283.61,,,,,,,,,,,,,,,,,,,Other,87.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,87.36,87.36, KIT BUTTON REPLACEMENT 28FR X 2,272,RC,,,,,,both,1595.36,1116.75,,,,,,,,,,,,,,,,,,,Other,343.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,343.96,343.96, KIT BUTTON REPLACEMENT 28,272,RC,,,,,,both,1342.11,939.48,,,,,,,,,,,,,,,,,,,Other,289.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,289.35,289.35, KIT BUTTON REPLACEMENT 28,272,RC,,,,,,both,1229.95,860.97,,,,,,,,,,,,,,,,,,,Other,265.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,265.18,265.18, KIT BUTTON REPLACEMENT 24,272,RC,,,,,,both,1595.36,1116.75,,,,,,,,,,,,,,,,,,,Other,343.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,343.96,343.96, KIT BUTTON REPLACEMENT 24FR,272,RC,,,,,,both,1128.66,790.06,,,,,,,,,,,,,,,,,,,Other,243.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,243.34,243.34, KIT BUTTON REPLACEMENT 24,272,RC,,,,,,both,969.11,678.38,,,,,,,,,,,,,,,,,,,Other,208.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,208.94,208.94, "R ANGLE 12' BUTTON EXT SET ""Y""PORT W/CAP",272,RC,,,,,,both,95.89,67.12,,,,,,,,,,,,,,,,,,,Other,20.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.68,20.68, EVAL KIT BUTTON REPLACEMENT 24,272,RC,,,,,,both,919.69,643.78,,,,,,,,,,,,,,,,,,,Other,198.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,198.28,198.28, GRAFT BIFURCATED 16/,C1768,HCPCS,278,RC,,,,both,3294.1,2305.87,,,,,,,,,,,,,,,,,,,Other,710.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,710.21,710.21, GRAFT BIFURCATED 18/9/,C1768,HCPCS,278,RC,,,,both,2742.16,1919.51,,,,,,,,,,,,,,,,,,,Other,591.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,591.21,591.21, EXERCISER VOLUMETRIC 2500ML,270,RC,,,,,,both,20.6,14.42,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.44,4.44, GRAFT HEMOSHIELD GOLD TUBE 16MMX30CM,C1768,HCPCS,278,RC,,,,both,1968.73,1378.11,,,,,,,,,,,,,,,,,,,Other,424.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,424.46,424.46, GRAFT SURGISIS BIODESIGN 20X20,C1768,HCPCS,278,RC,,,,both,24046.67,16832.67,,,,,,,,,,,,,,,,,,,Other,5184.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5184.46,5184.46, GRAFT SURGISIS BIODESIGN 20X30,C1768,HCPCS,278,RC,,,,both,33064.16,23144.91,,,,,,,,,,,,,,,,,,,Other,7128.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7128.64,7128.64, RETAINER GLASSMAN LARGE (FISH),272,RC,,,,,,both,85.95,60.17,,,,,,,,,,,,,,,,,,,Other,18.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.53,18.53, CATH SILICONE 12FR 10CC,A4344,HCPCS,272,RC,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO RETAINER GLASSMAN JUMBO,272,RC,,,,,,both,185.21,129.65,,,,,,,,,,,,,,,,,,,Other,39.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.94,39.94, DEFOGGER FRED,272,RC,,,,,,both,20.6,14.42,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.44,4.44, SET BLOOD/FLUID WARMI,272,RC,,,,,,both,35.1,24.57,,,,,,,,,,,,,,,,,,,Other,7.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.57,7.57, CATH SILICONE 22FR 5CC,272,RC,,,,,,both,32.52,22.76,,,,,,,,,,,,,,,,,,,Other,7.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.01,7.01, CATH GUIDING VISTA BRITE TIP 7FR H-STICK,278,RC,,,,,,both,284.68,199.28,,,,,,,,,,,,,,,,,,,Other,61.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.38,61.38, CLEARIFY VISUALIZATION SYSTEM,272,RC,,,,,,both,175.64,122.95,,,,,,,,,,,,,,,,,,,Other,37.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.87,37.87, CATH SILICONE 26FR 5CC RETENTION,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, SYSTEM CD-SET BAXTER,272,RC,,,,,,both,118.04,82.63,,,,,,,,,,,,,,,,,,,Other,25.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.45,25.45, DNO CATH SILICONE 16FR 30CC,272,RC,,,,,,both,22.44,15.71,,,,,,,,,,,,,,,,,,,Other,4.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.84,4.84, DNO CATH HEMO 16FR 30CC,C1752,HCPCS,278,RC,,,,both,20.6,14.42,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.44,4.44, GRAFT VASC VENAFLO II 6MMX40CM STRAI,C1768,HCPCS,278,RC,,,,both,2239.44,1567.61,,,,,,,,,,,,,,,,,,,Other,482.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,482.83,482.83, DNO CATHETER 6FR FOLEY PEDIATRIC,A4344,HCPCS,272,RC,,,,both,54.33,38.03,,,,,,,,,,,,,,,,,,,Other,11.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.71,11.71, CATHETER 8FR FOLEY PEDIATRIC,A4344,HCPCS,272,RC,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, CATHETER - AINTREE INTUBATION,272,RC,,,,,,both,200.95,140.67,,,,,,,,,,,,,,,,,,,Other,43.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.33,43.33, CATH SILICONE 20FR 30CC,272,RC,,,,,,both,22.44,15.71,,,,,,,,,,,,,,,,,,,Other,4.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.84,4.84, CATH SILICONE 16FR 30CC FOLEY 3-WAY,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, GRAFT THIN WALLED REMOVABLE RINGS,C1768,HCPCS,278,RC,,,,both,4314.29,3020,,,,,,,,,,,,,,,,,,,Other,930.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,930.16,930.16, CATH SILICONE 28FR 5CC RETENTION,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, GRAFT RINGED 10 X 80,C1768,HCPCS,278,RC,,,,both,4765.23,3335.66,,,,,,,,,,,,,,,,,,,Other,1027.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1027.38,1027.38, GRAFT STRETCH 6MMX40CM,C1768,HCPCS,278,RC,,,,both,1904.76,1333.33,,,,,,,,,,,,,,,,,,,Other,410.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,410.67,410.67, GRAFT VASC 6 X 10,C1768,HCPCS,278,RC,,,,both,5495.25,3846.68,,,,,,,,,,,,,,,,,,,Other,1184.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1184.78,1184.78, CATH SILICONE 10FR 3CC M/L PEDIATRIC,A4344,HCPCS,272,RC,,,,both,33.46,23.42,,,,,,,,,,,,,,,,,,,Other,7.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.21,7.21, GRAFT BI-FURCATED 16X8,C1768,HCPCS,278,RC,,,,both,2487.41,1741.19,,,,,,,,,,,,,,,,,,,Other,536.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,536.29,536.29, GRAFT STRAIGHT 8MMX80,C1768,HCPCS,278,RC,,,,both,3341.52,2339.06,,,,,,,,,,,,,,,,,,,Other,720.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,720.43,720.43, GRAFT VASC 6MMX40CM,C1768,HCPCS,278,RC,,,,both,3310.8,2317.56,,,,,,,,,,,,,,,,,,,Other,713.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,713.81,713.81, MESH ATRIUM CQUR 15X20CM,278,RC,,,,,,both,2552.48,1786.74,,,,,,,,,,,,,,,,,,,Other,550.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,550.32,550.32, MESH PATCH DUAL 20X30,C1781,HCPCS,278,RC,,,,both,7543.17,5280.22,,,,,,,,,,,,,,,,,,,Other,1626.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1626.31,1626.31, MESH PATCH DUAL 15X19,C1781,HCPCS,278,RC,,,,both,4010.51,2807.36,,,,,,,,,,,,,,,,,,,Other,864.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,864.66,864.66, MESH PATCH DUAL10X15,C1781,HCPCS,278,RC,,,,both,2160.56,1512.39,,,,,,,,,,,,,,,,,,,Other,465.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,465.81,465.81, MESH PATCH SOFT TISSUE 15X,C1781,HCPCS,278,RC,,,,both,5928.72,4150.1,,,,,,,,,,,,,,,,,,,Other,1278.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1278.23,1278.23, GRAFT BIFURCATED KNITTED 12MMX6MM,C1768,HCPCS,278,RC,,,,both,2167.38,1517.17,,,,,,,,,,,,,,,,,,,Other,467.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,467.28,467.28, GRAFT VASC PROPATEN 6MMX80CM,C1768,HCPCS,278,RC,,,,both,8055.15,5638.61,,,,,,,,,,,,,,,,,,,Other,1736.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1736.69,1736.69, GRAFT VASC PROPATEN 6MMX50CM,C1768,HCPCS,278,RC,,,,both,5324.59,3727.21,,,,,,,,,,,,,,,,,,,Other,1147.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1147.98,1147.98, GRAFT VASC PROPATEN 8MMX50CM,C1768,HCPCS,278,RC,,,,both,5324.59,3727.21,,,,,,,,,,,,,,,,,,,Other,1147.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1147.98,1147.98, CATH 3WAY 18FR 5CC IRRIGATION,A4346,HCPCS,272,RC,,,,both,36.91,25.84,,,,,,,,,,,,,,,,,,,Other,7.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.96,7.96, CATH 3WAY 22FR 30CC IRRIGATION,A4346,HCPCS,272,RC,,,,both,20.01,14.01,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, CATH 3WAY 24FR 30CC,A4346,HCPCS,272,RC,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, CATH 3WAY 26FR 30CC IRRIGATION,A4346,HCPCS,272,RC,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, CATH ANGIO 4FR-.035-100CM-JB2,272,RC,,,,,,both,55.97,39.18,,,,,,,,,,,,,,,,,,,Other,12.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.06,12.06, CATH ANGIO 4FR-.035-100CM-H1,272,RC,,,,,,both,55.97,39.18,,,,,,,,,,,,,,,,,,,Other,12.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.06,12.06, TROCAR ARGYLE 16FR,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, TROCAR ARGYLE 20FR,272,RC,,,,,,both,109.8,76.86,,,,,,,,,,,,,,,,,,,Other,23.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.68,23.68, TRAY CATHETER 16 FR LF,272,RC,,,,,,both,28.57,20,,,,,,,,,,,,,,,,,,,Other,6.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.16,6.16, CATH 8FR CONE TIP URETERAL,272,RC,,,,,,both,72.9,51.03,,,,,,,,,,,,,,,,,,,Other,15.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.72,15.72, TRAY CATHETER W/D FDL,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, CATH 5FR CONE TIP URETERAL,272,RC,,,,,,both,71.08,49.76,,,,,,,,,,,,,,,,,,,Other,15.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.33,15.33, CATH ANGIO 4FR-.035-100CM,272,RC,,,,,,both,60.55,42.39,,,,,,,,,,,,,,,,,,,Other,13.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.05,13.05, MESH SOFT TISUE 10 X,C1781,HCPCS,278,RC,,,,both,2058.16,1440.71,,,,,,,,,,,,,,,,,,,Other,443.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,443.74,443.74, "CATH ANGIO 14G 5.25""",272,RC,,,,,,both,55.43,38.8,,,,,,,,,,,,,,,,,,,Other,11.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.95,11.95, PRO PORT SYSTEM LOW PROFILE 1.0MM 6FR,272,RC,,,,,,both,1023.98,716.79,,,,,,,,,,,,,,,,,,,Other,220.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,220.77,220.77, PORT TITANIUM IMPLATED W/CATH,278,RC,,,,,,both,2328.58,1630.01,,,,,,,,,,,,,,,,,,,Other,502.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,502.04,502.04, TRAY URETHRAL 14FR D,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SET NEPHROSTOMY ULTRATHANE,272,RC,,,,,,both,745.14,521.6,,,,,,,,,,,,,,,,,,,Other,160.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,160.65,160.65, PERCUTANEOUS NEPHROSTOMY SET,272,RC,,,,,,both,762.14,533.5,,,,,,,,,,,,,,,,,,,Other,164.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,164.32,164.32, SET NEPHROSTOMY ULTRATHANE 8.5FR,272,RC,,,,,,both,820.51,574.36,,,,,,,,,,,,,,,,,,,Other,176.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,176.9,176.9, CATH NEPHROSTOMY 10FR PERCUFLEX,272,RC,,,,,,both,440.49,308.34,,,,,,,,,,,,,,,,,,,Other,94.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,94.97,94.97, DNO SUTURE VICRYL #1 CT-1 ETH J947H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DILATOR NAVAGATION HD 12/14 FR,C1894,HCPCS,278,RC,,,,both,673.83,471.68,,,,,,,,,,,,,,,,,,,Other,145.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,145.28,145.28, REFURB MED SLEEVE COMPRESSION,271,RC,,,,,,both,36.16,25.31,,,,,,,,,,,,,,,,,,,Other,7.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.8,7.8, SM SLEEVE COMPRESSION,271,RC,,,,,,both,90.24,63.17,,,,,,,,,,,,,,,,,,,Other,19.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.45,19.45, MED SLEEVE COMPRESSION,271,RC,,,,,,both,56.53,39.57,,,,,,,,,,,,,,,,,,,Other,12.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.19,12.19, LG SLEEVE COMPRESSION,271,RC,,,,,,both,96.5,67.55,,,,,,,,,,,,,,,,,,,Other,20.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.81,20.81, SLEEVE SCD EXTRA LARGE BARIATRIC,271,RC,,,,,,both,98.65,69.06,,,,,,,,,,,,,,,,,,,Other,21.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,21.27,21.27, DNO SLEEVE SCD MEDIUM KNEE,271,RC,,,,,,both,150.75,105.53,,,,,,,,,,,,,,,,,,,Other,32.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.51,32.51, SNARE 4FR AMPLTZ 10/,272,RC,,,,,,both,860.49,602.34,,,,,,,,,,,,,,,,,,,Other,185.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,185.52,185.52, CATH PERCUTANEOUS 10F 30CM,272,RC,,,,,,both,215.41,150.79,,,,,,,,,,,,,,,,,,,Other,46.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,46.44,46.44, DNO CATH PERCUTANEOUS 12FR,272,RC,,,,,,both,220.07,154.05,,,,,,,,,,,,,,,,,,,Other,47.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.45,47.45, DNO SET TRIPLE PRESSURE TRANSDUCER,272,RC,,,,,,both,166.5,116.55,,,,,,,,,,,,,,,,,,,Other,35.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.9,35.9, TRANSDUCER KIT PRESSURE MONITOR,272,RC,,,,,,both,70.73,49.51,,,,,,,,,,,,,,,,,,,Other,15.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.25,15.25, SALIVARY DUCT CATHETER,272,RC,,,,,,both,333.66,233.56,,,,,,,,,,,,,,,,,,,Other,71.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.94,71.94, SLING TRANSVAGINAL MID-URETHRAL SYSTEM,278,RC,,,,,,both,3125.84,2188.09,,,,,,,,,,,,,,,,,,,Other,673.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,673.93,673.93, T.V.T URINARY,C2631,HCPCS,278,RC,,,,both,2952.42,2066.69,,,,,,,,,,,,,,,,,,,Other,636.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,636.54,636.54, TVT ADVANTAGE SYSTEM,C2631,HCPCS,278,RC,,,,both,4783.33,3348.33,,,,,,,,,,,,,,,,,,,Other,1031.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1031.28,1031.28, SLING SYSTEM MID URETHRAL,278,RC,,,,,,both,4355.11,3048.58,,,,,,,,,,,,,,,,,,,Other,938.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,938.96,938.96, RETRIVAL DEPLOYMENT DEVICE,278,RC,,,,,,both,1052.29,736.6,,,,,,,,,,,,,,,,,,,Other,226.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,226.87,226.87, HEATED BREATHING CIRCUIT W/ CHAMBER,272,RC,,,,,,both,98,68.6,,,,,,,,,,,,,,,,,,,Other,21.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,21.13,21.13, FLEX POINT ELECTRODE UNIV ROLLERBLL,272,RC,,,,,,both,428.33,299.83,,,,,,,,,,,,,,,,,,,Other,92.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,92.35,92.35, ELECTRODE UNIV ROLLERBLL,272,RC,,,,,,both,495.46,346.82,,,,,,,,,,,,,,,,,,,Other,106.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,106.82,106.82, ELECTRODE COLLINS KNIFE 22/24 FR,272,RC,,,,,,both,250.7,175.49,,,,,,,,,,,,,,,,,,,Other,54.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,54.05,54.05, SHUNT 6 INCH CAROTID ARTERY,272,RC,,,,,,both,170.15,119.11,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.68,36.68, VASOSEAL ES,C1760,HCPCS,278,RC,,,,both,767.97,537.58,,,,,,,,,,,,,,,,,,,Other,165.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,165.57,165.57, HET BIPOLAR FORCEPS,272,RC,,,,,,both,2166.17,1516.32,,,,,,,,,,,,,,,,,,,Other,467.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,467.03,467.03, FORCEP ORANGE BIOPSY W/NEED,272,RC,,,,,,both,41.41,28.99,,,,,,,,,,,,,,,,,,,Other,8.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.93,8.93, BIOPSY RADIAL JAW HOT,272,RC,,,,,,both,151.36,105.95,,,,,,,,,,,,,,,,,,,Other,32.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.63,32.63, STAPLER 35 REGULAR COVIDIEN,272,RC,,,,,,both,28.78,20.15,,,,,,,,,,,,,,,,,,,Other,6.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.2,6.2, STAPLER 35W,272,RC,,,,,,both,31.16,21.81,,,,,,,,,,,,,,,,,,,Other,6.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.72,6.72, DNO STAPLER 21 MM CURVED,272,RC,,,,,,both,1229.54,860.68,,,,,,,,,,,,,,,,,,,Other,265.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,265.09,265.09, DISC STAPLER 35W ORTH,272,RC,,,,,,both,35.56,24.89,,,,,,,,,,,,,,,,,,,Other,7.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.66,7.66, DNO STAPLER 30MM TX30V LINEAR VASCULAR,272,RC,,,,,,both,262.08,183.46,,,,,,,,,,,,,,,,,,,Other,56.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,56.51,56.51, LINEAR CUTTER 55MM,272,RC,,,,,,both,390.85,273.6,,,,,,,,,,,,,,,,,,,Other,84.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,84.27,84.27, SHEARS 5 MM CURVED HARMONIC,272,RC,,,,,,both,1258.46,880.92,,,,,,,,,,,,,,,,,,,Other,271.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,271.32,271.32, PIRANHA URETEROSCOPIC BIOPSY FORCEP,272,RC,,,,,,both,1153.38,807.37,,,,,,,,,,,,,,,,,,,Other,248.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,248.67,248.67, HEMOCLIP 25 MED ENDOSCOPIC GRN,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, HEMOCLIP RELAY ENDOSCOPIC 16MMX230CM,272,RC,,,,,,both,263.07,184.15,,,,,,,,,,,,,,,,,,,Other,56.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,56.72,56.72, CLIP HEMOLOK WECK LARGE,272,RC,,,,,,both,125.05,87.54,,,,,,,,,,,,,,,,,,,Other,26.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.96,26.96, DNO STAPLER 33 MM CURVED,272,RC,,,,,,both,737.23,516.06,,,,,,,,,,,,,,,,,,,Other,158.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,158.95,158.95, MICROFX OCD UNIVERSAL DRILL,272,RC,,,,,,both,1975.6,1382.92,,,,,,,,,,,,,,,,,,,Other,425.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,425.94,425.94, HEMOSPRAY,272,RC,,,,,,both,5145.35,3601.75,,,,,,,,,,,,,,,,,,,Other,1109.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1109.34,1109.34, DISC STAPLER CURVED 25MM,272,RC,,,,,,both,737.26,516.08,,,,,,,,,,,,,,,,,,,Other,158.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,158.96,158.96, STAPLER ECS 21 MM ENDOSCOPIC,272,RC,,,,,,both,1306.14,914.3,,,,,,,,,,,,,,,,,,,Other,281.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,281.6,281.6, STAPLER PROXIMATE LINEAR TX30G,272,RC,,,,,,both,228.39,159.87,,,,,,,,,,,,,,,,,,,Other,49.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,49.24,49.24, DNO STAPLER 25MM CIRCULAR 370MM 28CM,272,RC,,,,,,both,797.79,558.45,,,,,,,,,,,,,,,,,,,Other,172,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,172,172, DNO STAPLER RELOAD 60MM WHITE,272,RC,,,,,,both,538.86,377.2,,,,,,,,,,,,,,,,,,,Other,116.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,116.18,116.18, LINEAR CUTTER 75 MM,272,RC,,,,,,both,589.11,412.38,,,,,,,,,,,,,,,,,,,Other,127.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,127.01,127.01, DNO RELOAD 30MM TX30 LINEAR BLUE,272,RC,,,,,,both,182.8,127.96,,,,,,,,,,,,,,,,,,,Other,39.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.42,39.42, DNO RELOAD LINEAR CUTTER 75MM,272,RC,,,,,,both,190.3,133.21,,,,,,,,,,,,,,,,,,,Other,41.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.03,41.03, RELOAD 30MM TX30 LINEAR GREEN,272,RC,,,,,,both,167.4,117.18,,,,,,,,,,,,,,,,,,,Other,36.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.09,36.09, CUTTER 4.0MM TOMCAT,272,RC,,,,,,both,221.85,155.3,,,,,,,,,,,,,,,,,,,Other,47.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.83,47.83, CUTTER ANGLED AGGRESSIVE 5.0MM,272,RC,,,,,,both,181.65,127.16,,,,,,,,,,,,,,,,,,,Other,39.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.16,39.16, BUR 5.5MM ROUND 12 FLUTE - HOLLOW,272,RC,,,,,,both,234.24,163.97,,,,,,,,,,,,,,,,,,,Other,50.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.5,50.5, BUR 4.0MM BARREL 12 FLUTE HOLLOW,272,RC,,,,,,both,209.85,146.9,,,,,,,,,,,,,,,,,,,Other,45.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,45.25,45.25, BUR 5.5MM BARREL 12 FLUTE HOLLOW,272,RC,,,,,,both,234.24,163.97,,,,,,,,,,,,,,,,,,,Other,50.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.5,50.5, CUTTER 4.0 AGGRESSIVE PLUS,272,RC,,,,,,both,184.5,129.15,,,,,,,,,,,,,,,,,,,Other,39.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.78,39.78, CUTTER 4.0MM RESECTOR,272,RC,,,,,,both,206.28,144.4,,,,,,,,,,,,,,,,,,,Other,44.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.47,44.47, SERFAS ENERGY SUPER 90-S,272,RC,,,,,,both,640.92,448.64,,,,,,,,,,,,,,,,,,,Other,138.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,138.18,138.18, PROBE 3.5MM HOOK SERFAS ENERGY,272,RC,,,,,,both,482.63,337.84,,,,,,,,,,,,,,,,,,,Other,104.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,104.06,104.06, SCALPEL HARMONIC HAND HELD 36CM,272,RC,,,,,,both,1362.2,953.54,,,,,,,,,,,,,,,,,,,Other,293.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,293.69,293.69, TUBING INSUFFLATION HYSTEROSCOPIC CROSS/,272,RC,,,,,,both,227.11,158.98,,,,,,,,,,,,,,,,,,,Other,48.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,48.96,48.96, TUBING INSUFFLATION ARTHROSCOPIC INFLOW,272,RC,,,,,,both,196.79,137.75,,,,,,,,,,,,,,,,,,,Other,42.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.42,42.42, SERFAS ENERGY 90-S CRUISE,272,RC,,,,,,both,582.34,407.64,,,,,,,,,,,,,,,,,,,Other,125.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,125.55,125.55, RESECTOR SHAVER BLADE F-SERIES-5.5MM,272,RC,,,,,,both,232.51,162.76,,,,,,,,,,,,,,,,,,,Other,50.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.13,50.13, GRAFT VASC 22,C1768,HCPCS,278,RC,,,,both,1529.28,1070.5,,,,,,,,,,,,,,,,,,,Other,329.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,329.71,329.71, GRAFT VASC 26,C1768,HCPCS,278,RC,,,,both,1669.91,1168.94,,,,,,,,,,,,,,,,,,,Other,360.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,360.03,360.03, ROUND SILICON DRAIN 10FR,272,RC,,,,,,both,30.75,21.53,,,,,,,,,,,,,,,,,,,Other,6.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.63,6.63, DRAIN WOUND 19FR ROUND FLUTED W/O TROCAR,272,RC,,,,,,both,47.15,33.01,,,,,,,,,,,,,,,,,,,Other,10.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.16,10.16, DRAIN SILICONE 7MM FLAT,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, DRAIN JACKSON PRATT 10MM FLAT,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, RESERVOIR 100ML JACK/,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, DRAIN SILICONE 15FR,272,RC,,,,,,both,28.99,20.29,,,,,,,,,,,,,,,,,,,Other,6.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.25,6.25, DNO DRAIN JACKSON PRATT 19FR,272,RC,,,,,,both,22.26,15.58,,,,,,,,,,,,,,,,,,,Other,4.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.8,4.8, "SURGICEL FIBRILLAR 2""X4""",272,RC,,,,,,both,656.64,459.65,,,,,,,,,,,,,,,,,,,Other,141.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,141.57,141.57, 6X24 URETERAL STENT,C1874,HCPCS,278,RC,,,,both,371.93,260.35,,,,,,,,,,,,,,,,,,,Other,80.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,80.18,80.18, 6X26 URETERAL STENT,C1874,HCPCS,278,RC,,,,both,371.93,260.35,,,,,,,,,,,,,,,,,,,Other,80.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,80.18,80.18, 6X28 URETERAL STENT,C1874,HCPCS,278,RC,,,,both,371.93,260.35,,,,,,,,,,,,,,,,,,,Other,80.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,80.18,80.18, 7X28 CONTOUR URETERAL STENT,C1874,HCPCS,278,RC,,,,both,368.23,257.76,,,,,,,,,,,,,,,,,,,Other,79.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,79.39,79.39, TB-0009OF SET,272,RC,,,,,,both,1356.58,949.61,,,,,,,,,,,,,,,,,,,Other,292.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,292.48,292.48, DNO HANDPIECE THUNDERBEAT 35CM,272,RC,,,,,,both,3141.79,2199.25,,,,,,,,,,,,,,,,,,,Other,677.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,677.37,677.37, "DRAIN ""T"" 12FR BARD",272,RC,,,,,,both,30.29,21.2,,,,,,,,,,,,,,,,,,,Other,6.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.53,6.53, DNO SNARE POLYPECTOMY X-SMALL,272,RC,,,,,,both,67.13,46.99,,,,,,,,,,,,,,,,,,,Other,14.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.47,14.47, SUTURE 6-0 VICRYL PS-3,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, DNO TUBE TRACH 4,A7521,HCPCS,272,RC,,,,both,222.84,155.99,,,,,,,,,,,,,,,,,,,Other,48.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,48.04,48.04, DNO TUBE TRACH FENESTRATED 4,A7521,HCPCS,272,RC,,,,both,148.82,104.17,,,,,,,,,,,,,,,,,,,Other,32.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.09,32.09, TRACHEOSTOMY TUBE 7.5MM ID CUFFED,A7521,HCPCS,272,RC,,,,both,148.53,103.97,,,,,,,,,,,,,,,,,,,Other,32.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.03,32.03, DNO TUBE TRACH FENESTRATED 6,A7521,HCPCS,272,RC,,,,both,225.04,157.53,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,48.52,48.52, DNO TUBE TRACH 8,272,RC,,,,,,both,222.9,156.03,,,,,,,,,,,,,,,,,,,Other,48.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,48.06,48.06, TUBE TRACH CUFFED 8.0,A7521,HCPCS,272,RC,,,,both,216.41,151.49,,,,,,,,,,,,,,,,,,,Other,46.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,46.66,46.66, TUBE TRACH 10,A7521,HCPCS,272,RC,,,,both,195.84,137.09,,,,,,,,,,,,,,,,,,,Other,42.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.22,42.22, DNO TUBE TRACH 10 FEN,A7521,HCPCS,272,RC,,,,both,215.43,150.8,,,,,,,,,,,,,,,,,,,Other,46.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,46.44,46.44, TUBE TRACH 8.5 SHILEY CUFFED W/ CANNULA,A7521,HCPCS,272,RC,,,,both,190.08,133.06,,,,,,,,,,,,,,,,,,,Other,40.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.98,40.98, DNO TUBE TRACH 8 FEN DISPOSABLE,A7521,HCPCS,272,RC,,,,both,183.05,128.14,,,,,,,,,,,,,,,,,,,Other,39.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.46,39.46, DNO TUBE TRACH 4 FEN CUFFLESS,A7520,HCPCS,272,RC,,,,both,130.46,91.32,,,,,,,,,,,,,,,,,,,Other,28.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28.13,28.13, TUBE TRACH 6 SHILEY CUFFLESS,A7520,HCPCS,272,RC,,,,both,165.27,115.69,,,,,,,,,,,,,,,,,,,Other,35.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.63,35.63, DNO TUBE TRACH 4 SHILEY FEN CUFFLESS,A7520,HCPCS,272,RC,,,,both,181.27,126.89,,,,,,,,,,,,,,,,,,,Other,39.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.08,39.08, TUBE TRACH 6 SHILEY FEN CUFFLESS,A7520,HCPCS,272,RC,,,,both,204.39,143.07,,,,,,,,,,,,,,,,,,,Other,44.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.07,44.07, TUBE TRACH 7 SHILEY W/ CUFF,A7520,HCPCS,272,RC,,,,both,154.38,108.07,,,,,,,,,,,,,,,,,,,Other,33.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,33.28,33.28, TUBE TRACH 6.5 SHILEY W/ CUFF,A7520,HCPCS,272,RC,,,,both,154.38,108.07,,,,,,,,,,,,,,,,,,,Other,33.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,33.28,33.28, "DNO FILTER EXTENSION SET 10"" 1.2 MICRON",272,RC,,,,,,both,21.63,15.14,,,,,,,,,,,,,,,,,,,Other,4.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.66,4.66, MESH DEXON 25X15CM,C1781,HCPCS,278,RC,,,,both,929.39,650.57,,,,,,,,,,,,,,,,,,,Other,200.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,200.38,200.38, MESH DEXON 20X10CM,C1781,HCPCS,278,RC,,,,both,902.28,631.6,,,,,,,,,,,,,,,,,,,Other,194.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,194.53,194.53, "PORT, 19MM, STRAIGHT, 80MM",C1788,HCPCS,278,RC,,,,both,824.81,577.37,,,,,,,,,,,,,,,,,,,Other,177.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,177.83,177.83, POWERPORT DUO MRI IMPLANTABLE 9.5 CF,278,RC,,,,,,both,2062,1443.4,,,,,,,,,,,,,,,,,,,Other,444.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,444.57,444.57, PRO PORT SYSTEM SINGLE LUMEN 1.6MM 8.5FR,272,RC,,,,,,both,1063.5,744.45,,,,,,,,,,,,,,,,,,,Other,229.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,229.29,229.29, PRO PORT SYSTEM LOW PROFILE 1.6MM 8.5FR,C1788,HCPCS,278,RC,,,,both,1126.74,788.72,,,,,,,,,,,,,,,,,,,Other,242.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,242.92,242.92, "MESH VICRYL KNITTED 12""X12""",C1781,HCPCS,278,RC,,,,both,4360.56,3052.39,,,,,,,,,,,,,,,,,,,Other,940.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,940.13,940.13, "MESH VICRYL WOV 12""X12""",C1781,HCPCS,278,RC,,,,both,3194.41,2236.09,,,,,,,,,,,,,,,,,,,Other,688.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,688.71,688.71, PORT MARS 19X60MM STRAIGHT DISPOSABLE,272,RC,,,,,,both,720.59,504.41,,,,,,,,,,,,,,,,,,,Other,155.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,155.36,155.36, PORT MARS 19X40MM STRAIGHT DISPOSABLE,272,RC,,,,,,both,720.59,504.41,,,,,,,,,,,,,,,,,,,Other,155.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,155.36,155.36, PORT MARS 19X70MM STRAIGHT DISPOSABLE,278,RC,,,,,,both,824.81,577.37,,,,,,,,,,,,,,,,,,,Other,177.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,177.83,177.83, PORT MARS 19X40MM STRAIGHT DISPOSABLE,278,RC,,,,,,both,720.59,504.41,,,,,,,,,,,,,,,,,,,Other,155.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,155.36,155.36, PORT MARS 19X90MM STRAIGHT DISPOSABLE,278,RC,,,,,,both,824.81,577.37,,,,,,,,,,,,,,,,,,,Other,177.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,177.83,177.83, PORT MARS 19X 120MM STRAIGHT DISPOSABLE,278,RC,,,,,,both,969.52,678.66,,,,,,,,,,,,,,,,,,,Other,209.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,209.02,209.02, PORT MARS 19X100MM STRAIGHT DISPOSABLE,278,RC,,,,,,both,969.52,678.66,,,,,,,,,,,,,,,,,,,Other,209.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,209.02,209.02, PORT MARS 19X110MM STRAIGHT DISPOSABLE,278,RC,,,,,,both,969.52,678.66,,,,,,,,,,,,,,,,,,,Other,209.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,209.02,209.02, CATH INFINITI 5FR JL-4,272,RC,,,,,,both,124.24,86.97,,,,,,,,,,,,,,,,,,,Other,26.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.78,26.78, LIGATOR,272,RC,,,,,,both,240.09,168.06,,,,,,,,,,,,,,,,,,,Other,51.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,51.76,51.76, STENT WALLFLEX ESOPHAGEAL 23MMX125MM,C1874,HCPCS,278,RC,,,,both,9265.58,6485.91,,,,,,,,,,,,,,,,,,,Other,1997.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1997.66,1997.66, STENT POLYFLEX 18X90,C1874,HCPCS,278,RC,,,,both,6992.89,4895.02,,,,,,,,,,,,,,,,,,,Other,1507.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1507.67,1507.67, STENT POLYFLEX 18X120,C1874,HCPCS,278,RC,,,,both,6992.89,4895.02,,,,,,,,,,,,,,,,,,,Other,1507.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1507.67,1507.67, STENT POLYFLEX ESOPHAGEAL 16X20X90,C1874,HCPCS,278,RC,,,,both,6160.41,4312.29,,,,,,,,,,,,,,,,,,,Other,1328.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1328.18,1328.18, STENT POLYFLEX ESOPHAGEAL 18X23X120,C1874,HCPCS,278,RC,,,,both,6160.41,4312.29,,,,,,,,,,,,,,,,,,,Other,1328.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1328.18,1328.18, STENT POLYFLEX 21X120,C1874,HCPCS,278,RC,,,,both,6992.89,4895.02,,,,,,,,,,,,,,,,,,,Other,1507.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1507.67,1507.67, STENT WALLFLEX ESOPHAGEAL,C1874,HCPCS,278,RC,,,,both,8408.12,5885.68,,,,,,,,,,,,,,,,,,,Other,1812.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1812.79,1812.79, MESH MARLEX 10 X 14,C1781,HCPCS,278,RC,,,,both,628.03,439.62,,,,,,,,,,,,,,,,,,,Other,135.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,135.41,135.41, STENT WALLFLEX COLONIC,C1874,HCPCS,278,RC,,,,both,8741.12,6118.78,,,,,,,,,,,,,,,,,,,Other,1884.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1884.59,1884.59, BREAST PROSTHESIS IMPLANTABLE,L8600,HCPCS,278,RC,,,,both,3071.87,2150.31,,,,,,,,,,,,,,,,,,,Other,662.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,662.29,662.29, MESH MYCRO 6CM X 12CM,C1781,HCPCS,278,RC,,,,both,457.37,320.16,,,,,,,,,,,,,,,,,,,Other,98.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,98.61,98.61, STENT WALLFLEX ESOPHAGEAL 23X155MM,C1874,HCPCS,278,RC,,,,both,8915.94,6241.16,,,,,,,,,,,,,,,,,,,Other,1922.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1922.28,1922.28, STENT WALLFLEX ESOPHAGEAL 18MM X 153MM,C1874,HCPCS,278,RC,,,,both,7727.57,5409.3,,,,,,,,,,,,,,,,,,,Other,1666.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1666.07,1666.07, WALLFLEX EXOPHAGEAL PARTIALLY COVERED 23,C1874,HCPCS,278,RC,,,,both,7727.57,5409.3,,,,,,,,,,,,,,,,,,,Other,1666.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1666.07,1666.07, TUBE TRAC 6 SHILEY CUF FEN D,A7520,HCPCS,272,RC,,,,both,133.05,93.14,,,,,,,,,,,,,,,,,,,Other,28.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28.68,28.68, TUBE TRACH 6 SHILEY XL CUFFED,A7520,HCPCS,272,RC,,,,both,199.07,139.35,,,,,,,,,,,,,,,,,,,Other,42.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.92,42.92, TUBE TRACH 8 XL SHILEY CUFFED,A7520,HCPCS,272,RC,,,,both,265.66,185.96,,,,,,,,,,,,,,,,,,,Other,57.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,57.28,57.28, TUBE TRACH 5 SHILEY XL CUFFLED,A7520,HCPCS,272,RC,,,,both,265.66,185.96,,,,,,,,,,,,,,,,,,,Other,57.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,57.28,57.28, SIZER 68HP 500CC,272,RC,,,,,,both,194.59,136.21,,,,,,,,,,,,,,,,,,,Other,41.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.95,41.95, TUNNELER INSRT HICKMA,272,RC,,,,,,both,177.89,124.52,,,,,,,,,,,,,,,,,,,Other,38.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,38.36,38.36, FLEX PORT 20 MM,272,RC,,,,,,both,203.6,142.52,,,,,,,,,,,,,,,,,,,Other,43.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.89,43.89, CATH LUMEN 4FR 3,272,RC,,,,,,both,347.71,243.4,,,,,,,,,,,,,,,,,,,Other,74.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,74.97,74.97, CATH LUMEN 3FR 3,272,RC,,,,,,both,393.07,275.15,,,,,,,,,,,,,,,,,,,Other,84.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,84.75,84.75, CATH LUMEN 5FR 3,272,RC,,,,,,both,347.71,243.4,,,,,,,,,,,,,,,,,,,Other,74.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,74.97,74.97, SECURFIT STEM,278,RC,,,,,,both,19835.01,13884.51,,,,,,,,,,,,,,,,,,,Other,4276.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4276.43,4276.43, TRIDENT SHELL,272,RC,,,,,,both,7189.44,5032.61,,,,,,,,,,,,,,,,,,,Other,1550.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1550.05,1550.05, TRIDENT LINER,272,RC,,,,,,both,6135.78,4295.05,,,,,,,,,,,,,,,,,,,Other,1322.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1322.87,1322.87, STENT BALLOON CORINT 7MM/15MM,C1874,HCPCS,278,RC,,,,both,3812.79,2668.95,,,,,,,,,,,,,,,,,,,Other,822.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,822.03,822.03, "WINGED INFUSION SET 20G X 1""",272,RC,,,,,,both,23.16,16.21,,,,,,,,,,,,,,,,,,,Other,5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5,5, PORTEX ADAPTER BRONCHOSCOPE,272,RC,,,,,,both,31.46,22.02,,,,,,,,,,,,,,,,,,,Other,6.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.78,6.78, GUIDE WIRE PLATINUM PLUS,C1769,HCPCS,278,RC,,,,both,523.82,366.67,,,,,,,,,,,,,,,,,,,Other,112.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,112.94,112.94, C TAPER 36 MM HEAD,278,RC,,,,,,both,4369.99,3058.99,,,,,,,,,,,,,,,,,,,Other,942.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,942.17,942.17, SET PNEUMOTHORAX LANDERS,272,RC,,,,,,both,398.84,279.19,,,,,,,,,,,,,,,,,,,Other,85.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,85.99,85.99, SET ANESTHESIA PUMP,271,RC,,,,,,both,30.05,21.04,,,,,,,,,,,,,,,,,,,Other,6.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.48,6.48, PROSTHESIS 20MM X 10MM,278,RC,,,,,,both,1787.69,1251.38,,,,,,,,,,,,,,,,,,,Other,385.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,385.42,385.42, CATH AIR EX CHANGE 19FR 83 CM,272,RC,,,,,,both,218.78,153.15,,,,,,,,,,,,,,,,,,,Other,47.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.17,47.17, CATH AIR EX CHANGE 14FR 83 CM,272,RC,,,,,,both,218.78,153.15,,,,,,,,,,,,,,,,,,,Other,47.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.17,47.17, CATH AIR EXCHANGE 11FR 83 CM,272,RC,,,,,,both,218.78,153.15,,,,,,,,,,,,,,,,,,,Other,47.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.17,47.17, KIT ARTERIAL LINE,272,RC,,,,,,both,63.57,44.5,,,,,,,,,,,,,,,,,,,Other,13.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.71,13.71, CATH LUMEN MULTI KIT,C1751,HCPCS,272,RC,,,,both,184.5,129.15,,,,,,,,,,,,,,,,,,,Other,39.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.78,39.78, CATH SET-CNTRL VEIN,272,RC,,,,,,both,66.3,46.41,,,,,,,,,,,,,,,,,,,Other,14.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.3,14.3, CATH KIT RADIAL ART,272,RC,,,,,,both,73.39,51.37,,,,,,,,,,,,,,,,,,,Other,15.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.83,15.83, LOOP CUTTING 24 FR,272,RC,,,,,,both,220.32,154.22,,,,,,,,,,,,,,,,,,,Other,47.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.5,47.5, DNO NEEDLE TUOHY EPID,272,RC,,,,,,both,60.1,42.07,,,,,,,,,,,,,,,,,,,Other,12.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.96,12.96, NEEDLE-TUOHY EPID,272,RC,,,,,,both,21.75,15.23,,,,,,,,,,,,,,,,,,,Other,4.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.69,4.69, DNOSTIMUCATH CONT NERVE BLCK SET 17GX8CM,272,RC,,,,,,both,213.3,149.31,,,,,,,,,,,,,,,,,,,Other,45.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,45.99,45.99, DNO NEEDLE NERVE BLOCK PROBLO,272,RC,,,,,,both,41.08,28.76,,,,,,,,,,,,,,,,,,,Other,8.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.86,8.86, SET PNEUMOTHORAX TPT,272,RC,,,,,,both,337.17,236.02,,,,,,,,,,,,,,,,,,,Other,72.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,72.7,72.7, "DNO TUBE EXTENSION 8""",272,RC,,,,,,both,30.63,21.44,,,,,,,,,,,,,,,,,,,Other,6.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.61,6.61, TUBE NASOJEJUNOSTOMY 10FR 140CM,272,RC,,,,,,both,93.85,65.7,,,,,,,,,,,,,,,,,,,Other,20.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.24,20.24, CHEST DRAINAGE OASIS 2100ML,272,RC,,,,,,both,185.53,129.87,,,,,,,,,,,,,,,,,,,Other,40,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40,40, COLLECTION UNIT,272,RC,,,,,,both,130.6,91.42,,,,,,,,,,,,,,,,,,,Other,28.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28.16,28.16, SOLUTION POTASSIUM CHLORIDE 1000ML,258,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, PLUG ANAL FISTULA,272,RC,,,,,,both,3319.01,2323.31,,,,,,,,,,,,,,,,,,,Other,715.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,715.58,715.58, DNO SENSOR BIS XP QUATRO,272,RC,,,,,,both,93.73,65.61,,,,,,,,,,,,,,,,,,,Other,20.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.21,20.21, DNO SET CO 2 TUBING,271,RC,,,,,,both,45.1,31.57,,,,,,,,,,,,,,,,,,,Other,9.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.72,9.72, SET CO 2 TUBING STRYKER HIGH FLOW,271,RC,,,,,,both,180.12,126.08,,,,,,,,,,,,,,,,,,,Other,38.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,38.84,38.84, DNO SOLUTION DEXTROSE BAG 5% 100ML,J7042,HCPCS,258,RC,,,,both,20.58,14.41,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.28,4.44, SOLUTION DEXTROSE 5% ADVANTAGE,J7042,HCPCS,258,RC,,,,both,20.58,14.41,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.28,4.44, SOLUTION POTASSIUM CHLORIDE 1000ML,J3480,HCPCS,258,RC,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.12,4.31, SOLUTION DEXTROSE 5% 250ML,J7042,HCPCS,258,RC,,,,both,20.58,14.41,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.28,4.44, SOLUTION DEXTROSE 10% (BAG) 1000ML,J7042,HCPCS,258,RC,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.28,4.31, SOLUTION DEXTROSE 10%,J7042,HCPCS,258,RC,,,,both,20.58,14.41,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.28,4.44, SOLUTION DEXTROSE 5% 500ML,J7060,HCPCS,258,RC,,,,both,20.58,14.41,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.72,4.44, SOLUTION DEXTROSE 5% 1000ML,258,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SET ANESTHESIA 1.5ML,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, DNO SOLUTION DEXTROSE 5% SODIUM CL .225,J7042,HCPCS,258,RC,,,,both,27.14,19,,,,,,,,,,,,,,,,,,,Other,5.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.28,5.85, SOLUTION DEXTROSE 5% SOD CHLORIDE .45,J7042,HCPCS,258,RC,,,,both,20.58,14.41,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.28,4.44, SOLUTION DEXTROSE 5% SOD CHLORIDE .45,258,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SOLUTION DEXTROSE 5% NACL .9% 1000ML,258,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SOLUTION DEXTROSE 5% LAC/RINGER,258,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SOLUTION DEXTROSE 5% LAC/RINGER 1000ML,258,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUB SOLUTION LACTATED RINGER 500 ML,J7120,HCPCS,258,RC,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.33,4.31, SOLUTION SODIUM CHLORIDE 3%,J7042,HCPCS,258,RC,,,,both,24.3,17.01,,,,,,,,,,,,,,,,,,,Other,5.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.28,5.24, LACTATED RINGERS 1000 ML,J7120,HCPCS,258,RC,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.33,4.31, CLEARSIGHT FINGER CUFF LARGE,272,RC,,,,,,both,1229.28,860.5,,,,,,,,,,,,,,,,,,,Other,265.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,265.03,265.03, CLEARSIGHT FINGER CUFF MEDIUM,272,RC,,,,,,both,1229.28,860.5,,,,,,,,,,,,,,,,,,,Other,265.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,265.03,265.03, CLEARSIGHT FINGER CUFF SMALL,272,RC,,,,,,both,1229.28,860.5,,,,,,,,,,,,,,,,,,,Other,265.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,265.03,265.03, FLOTRAC SENSOR,272,RC,,,,,,both,1229.28,860.5,,,,,,,,,,,,,,,,,,,Other,265.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,265.03,265.03, DRESSING EPIFIX 3X3 CM,Q4186,HCPCS,636,RC,,,,both,669.96,468.97,,,,,,,,,,,,,,,,,,,Other,144.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.87,144.44, SOLUTION SODIUM CHLORIDE .9% 100ML,258,RC,,,,1,ML,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, DNO SOLUTION SODIUM CHLORIDE .9% 50ML,258,RC,,,,1,ML,both,22.07,15.45,,,,,,,,,,,,,,,,,,,Other,4.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.76,4.76, SOLUTION SOD CHLORIDE .9% 250ML,258,RC,,,,1,ML,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, DNO SOLUTION SODIUM CHLORIDE .9% AS,258,RC,,,,1,ML,both,22.29,15.6,,,,,,,,,,,,,,,,,,,Other,4.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.8,4.8, SUTURE TRICON 2 BLUE 30 T-56/HGS-21,272,RC,,,,,,both,25.98,18.19,,,,,,,,,,,,,,,,,,,Other,5.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.61,5.61, SOLUTION SOD CLORIDE 0.9% 500ML BAG,258,RC,,,,1,ML,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SODIUM CHLORIDE .9% 1000ML BAG,J3480,HCPCS,258,RC,,1,ML,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.12,4.31, SOLUTION SODIUM CHLORIDE .9% IR 500ML BT,258,RC,,,,1,ML,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SODIUM CHLORIDE .9% 1000ML,258,RC,,,,1,ML,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SOLUTION SODIUM CL BAG .9% IRG 3000ML,J7030,HCPCS,258,RC,,1,ML,both,28.34,19.84,,,,,,,,,,,,,,,,,,,Other,6.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.95,6.11, SOLUTION SODIUM CHLORIDE .9% 1500ML,J7030,HCPCS,258,RC,,1,ML,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.95,4.55, WATER STERILE 500ML,J7060,HCPCS,258,RC,,1,ML,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.72,4.31, WATER STERILE 1000ML,258,RC,,,,1,ML,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SOLUTION WATER STERILE 3000ML,258,RC,,,,1,ML,both,29.45,20.62,,,,,,,,,,,,,,,,,,,Other,6.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.35,6.35, SOLUTION WATER STERILE BAG 1000ML,A4217,HCPCS,272,RC,,1,ML,both,19.98,13.99,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SOLUTION WATER STERILE 1500ML BOTTLE,258,RC,,,,1,ML,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, NEEDLE NERVE BLOCK,272,RC,,,,,,both,28.37,19.86,,,,,,,,,,,,,,,,,,,Other,6.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.12,6.12, OCCLUDER VASCULAR 1.0,278,RC,,,,,,both,190.27,133.19,,,,,,,,,,,,,,,,,,,Other,41.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.02,41.02, OCCLUDER VASCULAR 1.5,C1766,HCPCS,278,RC,,,,both,251.99,176.39,,,,,,,,,,,,,,,,,,,Other,54.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,54.33,54.33, OCCLUDER VASCULAR 2.0,278,RC,,,,,,both,244.44,171.11,,,,,,,,,,,,,,,,,,,Other,52.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,52.7,52.7, OCCLUDER VASCULAR 2.5,278,RC,,,,,,both,244.44,171.11,,,,,,,,,,,,,,,,,,,Other,52.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,52.7,52.7, SOLUTION SODIUM CHLORIDE .45% 1000ML,258,RC,,,,1,ML,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SOLUTION SODIUM CHLORIDE .45% 250ML,258,RC,,,,1,ML,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SOLUTION SODIUM CHLORIDE .45% 500ML,258,RC,,,,1,ML,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SOLUTION PREMIX POTASSIUM CHL 1000ML,J3480,HCPCS,258,RC,,1,ML,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.12,4.31, DNO SET MANIFOLD EXT CAT 25CM,272,RC,,,,,,both,38.35,26.85,,,,,,,,,,,,,,,,,,,Other,8.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.27,8.27, TUBE BLAKEMORE 20FR,272,RC,,,,,,both,1146.65,802.66,,,,,,,,,,,,,,,,,,,Other,247.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,247.21,247.21, SHUNT-DENVR VENS-SRG,278,RC,,,,,,both,3975.69,2782.98,,,,,,,,,,,,,,,,,,,Other,857.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,857.16,857.16, STRATA 42866 FIXED PRESSURE VALVE,C1982,HCPCS,278,RC,,,,both,16566.02,11596.21,,,,,,,,,,,,,,,,,,,Other,3571.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3571.63,3571.63, ARES CATHETER KIT 95001,272,RC,,,,,,both,2246.62,1572.63,,,,,,,,,,,,,,,,,,,Other,484.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,484.37,484.37, STRATA PASSER 48409,272,RC,,,,,,both,514.49,360.14,,,,,,,,,,,,,,,,,,,Other,110.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,110.93,110.93, VASCU-GUARD W/APEX PROCESSING,271,RC,,,,,,both,817.78,572.45,,,,,,,,,,,,,,,,,,,Other,176.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,176.31,176.31, LG LIGACLIP,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, LS100 LIGACLIP,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, LIGACLIP HORIZON,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, "DNO DRESSING AQUACEL AG 4"" X 13.5""",272,RC,,,,,,both,156.26,109.38,,,,,,,,,,,,,,,,,,,Other,33.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,33.69,33.69, SUTURE ETHILON #2 LR ETH 490T,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, KIT EDLICH GAS LAVGE,271,RC,,,,,,both,28.82,20.17,,,,,,,,,,,,,,,,,,,Other,6.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.21,6.21, DNO CATH FOLEY 18FR 10CC COUDE TIP 2-WAY,A4340,HCPCS,272,RC,,,,both,13.56,9.49,,,,,,,,,,,,,,,,,,,Other,2.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.92,2.92, CATH COUDE 2-WAY 16FR 5CC,A4340,HCPCS,272,RC,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, CATH COUDE 20FR 5CC,A4340,HCPCS,272,RC,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, DNO CATH COUDE 22FR 30CC 3 WAY,272,RC,,,,,,both,81.34,56.94,,,,,,,,,,,,,,,,,,,Other,17.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.53,17.53, SHEATH INTRODUCER CP-,272,RC,,,,,,both,99.46,69.62,,,,,,,,,,,,,,,,,,,Other,21.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,21.44,21.44, SHEATH INTRODUCER CL-,272,RC,,,,,,both,181.62,127.13,,,,,,,,,,,,,,,,,,,Other,39.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.16,39.16, STAPLER TA90 4.8/D,272,RC,,,,,,both,1473.73,1031.61,,,,,,,,,,,,,,,,,,,Other,317.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,317.74,317.74, EVAL RELOAD TA 90 4.8,272,RC,,,,,,both,481.28,336.9,,,,,,,,,,,,,,,,,,,Other,103.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,103.76,103.76, RELOAD TA 90 3.5,272,RC,,,,,,both,178.42,124.89,,,,,,,,,,,,,,,,,,,Other,38.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,38.46,38.46, STENT PALMAZ UNMOUNTED XL 40C,C1874,HCPCS,278,RC,,,,both,5444.47,3811.13,,,,,,,,,,,,,,,,,,,Other,1173.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1173.82,1173.82, STENT PALMAZ UNMOUNTED XL 50C,C1874,HCPCS,278,RC,,,,both,5827.41,4079.19,,,,,,,,,,,,,,,,,,,Other,1256.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1256.39,1256.39, CATH PIGTAIL 5FR W/M,272,RC,,,,,,both,131.9,92.33,,,,,,,,,,,,,,,,,,,Other,28.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28.44,28.44, CATH SUPER TORQUE VERTEBRAL 5FR,272,RC,,,,,,both,64.64,45.25,,,,,,,,,,,,,,,,,,,Other,13.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.94,13.94, DNO STAPLER 60 MM TX60B LINER BLUE,272,RC,,,,,,both,245.15,171.61,,,,,,,,,,,,,,,,,,,Other,52.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,52.85,52.85, CONV STAPLER 60MM TX60 LINEAR GREEN,272,RC,,,,,,both,389.92,272.94,,,,,,,,,,,,,,,,,,,Other,84.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,84.06,84.06, DNO RELOAD 60MM TX60 LINEAR GREEN,272,RC,,,,,,both,153.13,107.19,,,,,,,,,,,,,,,,,,,Other,33.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,33.02,33.02, DNO RELOAD 60MM RX60B LINEAR BLUE,272,RC,,,,,,both,211.27,147.89,,,,,,,,,,,,,,,,,,,Other,45.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,45.55,45.55, SET VASCULAR DIALATOR,272,RC,,,,,,both,203.17,142.22,,,,,,,,,,,,,,,,,,,Other,43.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.81,43.81, 6FR 20CM VASCULAR DIALATOR,272,RC,,,,,,both,78.79,55.15,,,,,,,,,,,,,,,,,,,Other,16.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.98,16.98, 8FR 20CM VASCULAR DIALATOR,272,RC,,,,,,both,78.79,55.15,,,,,,,,,,,,,,,,,,,Other,16.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.98,16.98, "NEEDLE STIMULATOR 21G X 1.5"" (40MM)",272,RC,,,,,,both,40.43,28.3,,,,,,,,,,,,,,,,,,,Other,8.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.71,8.71, NEEDLE STIMULATOR 21G X 3 1/8 (80MM),272,RC,,,,,,both,48.95,34.27,,,,,,,,,,,,,,,,,,,Other,10.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.55,10.55, "NEEDLE STIMULATOR 22G X 2""",272,RC,,,,,,both,44.98,31.49,,,,,,,,,,,,,,,,,,,Other,9.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.7,9.7, STIMUPLEX ULTRA 360 INSULATED ECHOGENIC,272,RC,,,,,,both,50.8,35.56,,,,,,,,,,,,,,,,,,,Other,10.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.96,10.96, "DNO 20G 6"" ECHOBLOCK PTC30 ECHOGENIC",272,RC,,,,,,both,34.37,24.06,,,,,,,,,,,,,,,,,,,Other,7.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.41,7.41, "22G 2"" ECHOBLOCK PTC ECHOGENIC NEEDLE",272,RC,,,,,,both,28.11,19.68,,,,,,,,,,,,,,,,,,,Other,6.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.06,6.06, "17G 6"" ECHOTUOHY EPIDURAL NEEDLES",272,RC,,,,,,both,51.23,35.86,,,,,,,,,,,,,,,,,,,Other,11.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.04,11.04, "DNO 18G X 8"" TUOHY NEEDLES",272,RC,,,,,,both,46.91,32.84,,,,,,,,,,,,,,,,,,,Other,10.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.11,10.11, "DNO 22G 6"" TUOHY NEEDLES",272,RC,,,,,,both,46.91,32.84,,,,,,,,,,,,,,,,,,,Other,10.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.11,10.11, "Y22G 3.5"" TUOHY NEEDLES",272,RC,,,,,,both,38.7,27.09,,,,,,,,,,,,,,,,,,,Other,8.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.34,8.34, "22G 6"" ECHOBLOCK PTC30 ECHOGENIC NON-IN",272,RC,,,,,,both,34.37,24.06,,,,,,,,,,,,,,,,,,,Other,7.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.41,7.41, "20G 8"" ECHOBLOCK PTC30 ECHOGENIC NON-IN",272,RC,,,,,,both,34.37,24.06,,,,,,,,,,,,,,,,,,,Other,7.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.41,7.41, *22G 8' ECHOBLOCK PTC30 ECHGENIC NON-INS,272,RC,,,,,,both,34.37,24.06,,,,,,,,,,,,,,,,,,,Other,7.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.41,7.41, DNO COLD SNARE EXACTO 2.4MM 230CM,272,RC,,,,,,both,102.5,71.75,,,,,,,,,,,,,,,,,,,Other,22.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.1,22.1, SNARE 15MM 120MM,272,RC,,,,,,both,1159.01,811.31,,,,,,,,,,,,,,,,,,,Other,249.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,249.88,249.88, SNARE STANDARD 9-15DX120CML CATH,272,RC,,,,,,both,1071.21,749.85,,,,,,,,,,,,,,,,,,,Other,230.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,230.96,230.96, FELT PTFE TEFLON,272,RC,,,,,,both,720.28,504.2,,,,,,,,,,,,,,,,,,,Other,155.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,155.29,155.29, STENT PALMAZ 5FR X 80CM,C1874,HCPCS,278,RC,,,,both,3812.79,2668.95,,,,,,,,,,,,,,,,,,,Other,822.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,822.03,822.03, DNO ADHESIVE DERMABOND,272,RC,,,,,,both,87.66,61.36,,,,,,,,,,,,,,,,,,,Other,18.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.9,18.9, EXOFUSION SKIN CLOSURE SYSTEM 22CM,272,RC,,,,,,both,206.19,144.33,,,,,,,,,,,,,,,,,,,Other,44.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.45,44.45, DNO EXOFUSION SKIN CLOSURE SYSTEM 30 CM,272,RC,,,,,,both,226.46,158.52,,,,,,,,,,,,,,,,,,,Other,48.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,48.82,48.82, EXOFIN SURGICAL SKIN ADHESIVE 1ML,272,RC,,,,,,both,48.99,34.29,,,,,,,,,,,,,,,,,,,Other,10.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.56,10.56, ADHESIVE SURE&CLOSE WOUND CLOSURE SYS,272,RC,,,,,,both,81.82,57.27,,,,,,,,,,,,,,,,,,,Other,17.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.64,17.64, ADHESIVE BIO-GLUE,272,RC,,,,,,both,2757.06,1929.94,,,,,,,,,,,,,,,,,,,Other,594.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,594.42,594.42, SURGICAL SEALANT 4ML COSEAL,272,RC,,,,,,both,2109.45,1476.62,,,,,,,,,,,,,,,,,,,Other,454.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,454.8,454.8, HEMOSTATIC MATRIX FLOSEAL 5ML,C1713,HCPCS,272,RC,,,,both,532.73,372.91,,,,,,,,,,,,,,,,,,,Other,114.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,114.86,114.86, TACHOSIL SEALANT PATCH,272,RC,,,,,,both,2283.56,1598.49,,,,,,,,,,,,,,,,,,,Other,492.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,492.33,492.33, DURAGEN SECURE 3X3,272,RC,,,,,,both,3505.61,2453.93,,,,,,,,,,,,,,,,,,,Other,755.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,755.81,755.81, DNO DURASEAL 8CM APPLICATOR,272,RC,,,,,,both,873.83,611.68,,,,,,,,,,,,,,,,,,,Other,188.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,188.4,188.4, ENDOSCOPIC APPLICATOR FLOSEAL,272,RC,,,,,,both,242.1,169.47,,,,,,,,,,,,,,,,,,,Other,52.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,52.19,52.19, FIBRIN SEALANT 4ML TISSEEL,272,RC,,,,,,both,956.81,669.77,,,,,,,,,,,,,,,,,,,Other,206.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,206.29,206.29, ENDOSCOPIC APPLICATOR TISSEEL SPRAY SET,272,RC,,,,,,both,491.45,344.02,,,,,,,,,,,,,,,,,,,Other,105.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,105.96,105.96, TISSEEL EASY SPRAY SET W/PRESSURE REGULA,272,RC,,,,,,both,227.37,159.16,,,,,,,,,,,,,,,,,,,Other,49.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,49.02,49.02, HEMOSTATIC AGENT PERCLOT 1GM,C1052,HCPCS,272,RC,,,,both,365.97,256.18,,,,,,,,,,,,,,,,,,,Other,78.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,78.9,78.9, "BAG OSTOMY 2"" DRAINABLE",271,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, "SUTURE HI-FI 1X40""",272,RC,,,,,,both,104.43,73.1,,,,,,,,,,,,,,,,,,,Other,22.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.51,22.51, "SUTURE HI-FI 1X40"" 2 QTY TELFLEX",272,RC,,,,,,both,177.3,124.11,,,,,,,,,,,,,,,,,,,Other,38.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,38.23,38.23, SUTURE VICRYL 3-0 SH ETH J415H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE SILK 2-0 CT-1 ETH 423H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE MONOCRYL 5-0 PS-2 ETH Y495G,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, "CONV SUTURE VICRYL 3-0 SH 18"" J864D",272,RC,,,,,,both,38.34,26.84,,,,,,,,,,,,,,,,,,,Other,8.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.26,8.26, SUTURE CAPIO ABSORBABLE,272,RC,,,,,,both,146.67,102.67,,,,,,,,,,,,,,,,,,,Other,31.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,31.62,31.62, DNO SUTURE PROLENE 7-0 BV-1 30 ETH 8703H,272,RC,,,,,,both,62.19,43.53,,,,,,,,,,,,,,,,,,,Other,13.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.41,13.41, "CONV SUTURE PROLENE 2-0 SH 48"" ETH 8533H",272,RC,,,,,,both,30.71,21.5,,,,,,,,,,,,,,,,,,,Other,6.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.62,6.62, "CONV SUTURE PROLENE 3-0 SH 48"" ETH 8534H",272,RC,,,,,,both,29.8,20.86,,,,,,,,,,,,,,,,,,,Other,6.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.43,6.43, "SUTURE SILK 2-0 SH 30"" ETH C016D",272,RC,,,,,,both,47.74,33.42,,,,,,,,,,,,,,,,,,,Other,10.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.29,10.29, SUTURE SILK 2-0 CT-1 ETH C022D,272,RC,,,,,,both,35.19,24.63,,,,,,,,,,,,,,,,,,,Other,7.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.59,7.59, SUTURE SILK 3-0 REEL ETH LA-54-G,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE SILK 2-0 REEL ETH LA55G,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, "SUTURE SILK 2-0 30"" TIES ETH SA-85H",272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE CHROMIC #1 CT-1 ETH 925H,272,RC,,,,,,both,22.62,15.83,,,,,,,,,,,,,,,,,,,Other,4.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.88,4.88, SUTURE MONOCRYL 5-0 P-3 ETH Y493G,272,RC,,,,,,both,31.93,22.35,,,,,,,,,,,,,,,,,,,Other,6.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.88,6.88, CONV SUTURE VICRYL 3-0 SH VCP416H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE VICRYL 5-0 P-3 ETH J493G,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, CONV SUTURE VICRYL 2-0 CT-1 ETH J945H,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE VICRYL 2-0 UR-5 ETH J375H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE VICRYL 4-0 TIES ETH J643H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, CONV SUTURE VICRYL 0 CT-1 ETH J946H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, CONV SUTURE ETHILON P-3 ETH699G,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE PLAIN 6-0 (FAST ACTING)ETH 1916G,272,RC,,,,,,both,34.29,24,,,,,,,,,,,,,,,,,,,Other,7.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.39,7.39, SUTURE ETHIBOND #2 LR ETH X496T,272,RC,,,,,,both,23.87,16.71,,,,,,,,,,,,,,,,,,,Other,5.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.14,5.14, SUTURE PROLENE 4-0 PS-2 ETH 8682G,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, "SUTURE PROLENE 2-0 SH 36"" ETH 8523H",272,RC,,,,,,both,29.6,20.72,,,,,,,,,,,,,,,,,,,Other,6.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.38,6.38, SUTURE VICRYL ETH J232,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE SILK 6-0 P-3 ETH 1639G,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE SILK 4-0 SH ETH K831H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE VICRYL 0 CT-1 ETH J346H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, CONV SUTURE VICRYL 0 UR-5 ETH J376H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE VICRYL 0 8-18 J740D,272,RC,,,,,,both,37.79,26.45,,,,,,,,,,,,,,,,,,,Other,8.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.14,8.14, SUTURE VICRYL 4-0 PS-2 ETH J496H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE PLAIN 3-0 CT' ETH 842H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE CHROMIC 4-0 SH ETH G121H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE CHROMIC 0 CT' ETH 924H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE CHROMIC 2-0 CT' ETH 923H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE PROLENE 6-0 BV-1 ETH 8805H,272,RC,,,,,,both,109.1,76.37,,,,,,,,,,,,,,,,,,,Other,23.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.52,23.52, SUTURE MERSILENE 2-0 SH ETH R833H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE ETHIBOND 1 EXCEL OS-4 ETH X518H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE GZM 7-776 TEVDEK II 2 C-2,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, CONV SUTURE MONOCRYL 4-0 PC-3 ETH Y845G,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE VICRYL 1 CTX ETH J977H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE ETHIBOND 0 CT-1 ETH X424H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE ETHIBOND 4-0 X871H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, CATH SILICONE 14FR 5CC,A4338,HCPCS,272,RC,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE TI-CON COATED BRAIDED 5,272,RC,,,,,,both,47.93,33.55,,,,,,,,,,,,,,,,,,,Other,10.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.33,10.33, SUTURE ETHIBOND EXCEL X833H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE ETHIBOND 0 V-34 X444H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE ETHIBOND 0 OS-2 CX74T,272,RC,,,,,,both,35.72,25,,,,,,,,,,,,,,,,,,,Other,7.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.7,7.7, SUTURE VICRYL 70CM CP-2 J870H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE ETHIBOND 0 MO-6 CR/8,272,RC,,,,,,both,67.72,47.4,,,,,,,,,,,,,,,,,,,Other,14.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.6,14.6, SUTURE VICRYL 2-0 ETH J269H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE VICRYL CT-1 J260H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, CL-Gel-One(Hyaluronan)Intra-Articular In,J7326,HCPCS,636,RC,,1,EA,both,1848,1293.6,,,,,,,,,,,,,,,,,,,Other,398.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,517.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,398.43,517.49, SUTURE 0 TICRON HGS-22 D-TACH,272,RC,,,,,,both,48.62,34.03,,,,,,,,,,,,,,,,,,,Other,10.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.49,10.49, SUTURE 2 TICRON 5X30 KV-37,272,RC,,,,,,both,91.02,63.71,,,,,,,,,,,,,,,,,,,Other,19.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.62,19.62, CL-Gelsyn-3(Hyaluronan)0.1mg(Bill 168 un,J7328,HCPCS,614,RC,,1,EA,both,2.55,1.79,,,,,,,,,,,,,,,,,,,Other,0.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.55,0.66, SUTURE #1 MAXON GS-21,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, VIABAHN BX BALLON EXP ENDO/8MMX29MM 7FR1,C1874,HCPCS,278,RC,,,,both,11025.63,7717.94,,,,,,,,,,,,,,,,,,,Other,2377.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2377.13,2377.13, ZERO-P IMP 7MM LORDOTIC,C1776,HCPCS,278,RC,,,,both,4995,3496.5,,,,,,,,,,,,,,,,,,,Other,1076.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1076.92,1076.92, 3.0 TI CERV SPINE SCREW 16MM,C1713,HCPCS,278,RC,,,,both,333,233.1,,,,,,,,,,,,,,,,,,,Other,71.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.79,71.79, "SUTURE 3-0 CHROMIC GUT, V-20",272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 4-0 CHROMIC CV-23,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, OMNICURVE 10 G 20MM FRACTURE KIT,272,RC,,,,,,both,8125.43,5687.8,,,,,,,,,,,,,,,,,,,Other,1751.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1751.84,1751.84, OMNICURVE 10 G 15MM FRACTURE KIT,272,RC,,,,,,both,8125.43,5687.8,,,,,,,,,,,,,,,,,,,Other,1751.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1751.84,1751.84, VIABAHN BX BALLON EXP ENDO/7MMX29MM 6FR1,C1874,HCPCS,278,RC,,,,both,11025.63,7717.94,,,,,,,,,,,,,,,,,,,Other,2377.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2377.13,2377.13, DISTAL CENTRALIZER 16MM,C1776,HCPCS,278,RC,,,,both,183.15,128.21,,,,,,,,,,,,,,,,,,,Other,39.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.48,39.48, VERSYS HERITAGE17X150MM ST,C1776,HCPCS,278,RC,,,,both,4212.45,2948.72,,,,,,,,,,,,,,,,,,,Other,908.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,908.21,908.21, "SUTURE 3-0 SOFSILK 1X30"" V20",272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, VIABAHN BX BALLON EXP ENDO/8MMX29MM 7FR1,C1874,HCPCS,278,RC,,,,both,11025.63,7717.94,,,,,,,,,,,,,,,,,,,Other,2377.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2377.13,2377.13, SUTURE SILK 3-0 FS-1 ETH 684H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE SILK 3-0 K-S ETH 622H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE SILK 4-0 KS ETH 621H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE SILK 5-0 FS-2 ETH 682G,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE SILK 5-0 P-3 ETH 640G,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE SILK 6-0 C-3 ETH 711G,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE SILK 0 CT-1 ETH 424H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, "CONV SUTURE SILK 3-0 SH 30"" ETH K832H",272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, CONV SUTURE VICRYL 0 TIES ETH J616H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE VICRYL 4-0 P-3 ETH J494H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, CONV SUTURE VICRYL 2-0 UR-6 ETH J602H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE PROLENE 2-0 KS ETH 8623H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE PROLENE 2-0 FS-1 ETH 8685H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE PROLENE 3-0 KS ETH 8622H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE PROLENE 4-0 KS ETH 8621H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE PROLENE 5-0 FS-2 ETH 8661G,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE PROLENE 5-0 PS-5 ETH 8655G,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE PROLENE #1 CT-1 ETH 8425H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE PROLENE 0 MO-7 CR/8 ETH C841G,272,RC,,,,,,both,78.47,54.93,,,,,,,,,,,,,,,,,,,Other,16.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.91,16.91, SUTURE PROLENE 3-0 V-7 ETH 8976H,272,RC,,,,,,both,27.41,19.19,,,,,,,,,,,,,,,,,,,Other,5.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.91,5.91, "SUTURE PROLENE 4-0 SH 36"" ETH 8521H",272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE PROLENE 5-0 BV-1 ETH 9702H,272,RC,,,,,,both,109.63,76.74,,,,,,,,,,,,,,,,,,,Other,23.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.64,23.64, SUTURE PDS 4-0 SH ETH 9706H,272,RC,,,,,,both,34,23.8,,,,,,,,,,,,,,,,,,,Other,7.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.33,7.33, SUTURE PDS 4-0 II FS-1 ETH Z441H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE PDS #1 CT-1 ETH Z347H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE PDS 4-0 SH ETH Z315H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE CHROMIC #1 TIES ETH S115H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE CHROMIC 0 TIES ETH S114H,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE CHROMIC #2 TP-1 ETH GL31G,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE CHROMIC #1 TP-1 ETH GL30G,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE CHROMIC 0 BP-1 ETH 47T,272,RC,,,,,,both,23.87,16.71,,,,,,,,,,,,,,,,,,,Other,5.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.14,5.14, SUTURE CHROMIC 2-0 SH ETH G123H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE CHROMIC 3-0 CT-3 ETH 892H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, CONV SUTURE CHROMIC 4-0 RB-1 ETH U203H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE PLAIN 2-0 CT-1 ETH 843H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, CONV SUTURE ETHILON 2-0 FS ETH 664H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO SUTURE ETHILON 5-0 FS-2 ETH 661G,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE ETHILON 6-0 FS-3 DNR,272,RC,,,,,,both,48.48,33.94,,,,,,,,,,,,,,,,,,,Other,10.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.46,10.46, SUTURE CHROMIC 2-0 SH ETH 883H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, "DNO SUTURE TAPE 36""UMBILICAL SEE NOTES",272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE CHROMIC 3-0 CT-2 ETH 882H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE SURGICAL STEEL #7 CCS ETH M655G,272,RC,,,,,,both,79.31,55.52,,,,,,,,,,,,,,,,,,,Other,17.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.1,17.1, SUTURE SURGICAL STEEL #5 CCS ETH M653G,272,RC,,,,,,both,75.59,52.91,,,,,,,,,,,,,,,,,,,Other,16.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.3,16.3, SUTURE GORE 3N10B 3-0 GORTEX CV3,272,RC,,,,,,both,118.9,83.23,,,,,,,,,,,,,,,,,,,Other,25.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.64,25.64, SUTURE GORE 4N02A 4-0 GORTEX CV4,272,RC,,,,,,both,118.56,82.99,,,,,,,,,,,,,,,,,,,Other,25.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.56,25.56, SUTURE GORE 5N02A 5-0 GORTEX CV5,272,RC,,,,,,both,143.16,100.21,,,,,,,,,,,,,,,,,,,Other,30.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,30.87,30.87, SUTURE PROLENE #2 MS/3 ETH 3846T,272,RC,,,,,,both,51.07,35.75,,,,,,,,,,,,,,,,,,,Other,11.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.02,11.02, SUTURE SILK 4-0 FS-2 ETH 683G,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE GORE 6M02A 6-0 GORTEX CV6,272,RC,,,,,,both,147.94,103.56,,,,,,,,,,,,,,,,,,,Other,31.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,31.9,31.9, SUTURE 3-0 VICRYL CT-1 J258H,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, CONV SUTURE 5-0 NUROLON,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE 6-0 NUROLON,272,RC,,,,,,both,21.04,14.73,,,,,,,,,,,,,,,,,,,Other,4.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.54,4.54, SUTURE 4-0 PDS II PS-2 NEEDLE 18,272,RC,,,,,,both,27.11,18.98,,,,,,,,,,,,,,,,,,,Other,5.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.84,5.84, SUTURE 2-0 VICRYL CDT-2 NEEDLE 2,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE 5-0 PDS RB-1 NEEDLE,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SUTURE ETHICON ENDOLOOPS,272,RC,,,,,,both,204.96,143.47,,,,,,,,,,,,,,,,,,,Other,44.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.19,44.19, DNO SUTURE EHTIBOND EXCEL 1 CT,272,RC,,,,,,both,20.58,14.41,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.44,4.44, DNO SUTURE EHTBOND EXCEL 5CCS,272,RC,,,,,,both,63.2,44.24,,,,,,,,,,,,,,,,,,,Other,13.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.62,13.62, CONV SUTURE VICRYL 27,272,RC,,,,,,both,38.81,27.17,,,,,,,,,,,,,,,,,,,Other,8.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.37,8.37, PACK SHOULDER SPLIT,272,RC,,,,,,both,142.56,99.79,,,,,,,,,,,,,,,,,,,Other,30.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,30.73,30.73, SUTURE BONE WAX,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, CATH GROSHONG SINGLE LUMEN 7FR,C1751,HCPCS,272,RC,,,,both,1781.52,1247.06,,,,,,,,,,,,,,,,,,,Other,384.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,384.09,384.09, PACK ORTHO UPPER EXTREMITY,272,RC,,,,,,both,72.26,50.58,,,,,,,,,,,,,,,,,,,Other,15.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.58,15.58, PACK ORTHO LOWER EXTREMITY,272,RC,,,,,,both,165.54,115.88,,,,,,,,,,,,,,,,,,,Other,35.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.69,35.69, PACK CYSTO,272,RC,,,,,,both,23.16,16.21,,,,,,,,,,,,,,,,,,,Other,5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5,5, CYSTOSCOPE DISPOSABLE SCOPE,272,RC,,,,,,both,582.75,407.93,,,,,,,,,,,,,,,,,,,Other,125.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,125.65,125.65, HEMOSTASIS VALVE LARGE BORE,272,RC,,,,,,both,47.89,33.52,,,,,,,,,,,,,,,,,,,Other,10.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.33,10.33, PACK ORTHO MAJOR,272,RC,,,,,,both,73.37,51.36,,,,,,,,,,,,,,,,,,,Other,15.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.82,15.82, ANOSCOPE EXAM RTU 18MM X 103MM ANOSPEC,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, PACK ORTHOARTS HIP W/ POCKET,272,RC,,,,,,both,185.55,129.89,,,,,,,,,,,,,,,,,,,Other,40,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40,40, PACK BASIC II W/ UTILITY COVER,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, PACK KNEE ARTHROSCOPY/FLUID CONTROL,272,RC,,,,,,both,197.55,138.29,,,,,,,,,,,,,,,,,,,Other,42.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.59,42.59, PACK UNIVERSAL,272,RC,,,,,,both,71.26,49.88,,,,,,,,,,,,,,,,,,,Other,15.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.37,15.37, PACK SHOULDER ARTHROSCOPY ORTHOARTS,272,RC,,,,,,both,196.13,137.29,,,,,,,,,,,,,,,,,,,Other,42.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.29,42.29, PACK UNIVERSAL SPLIT SURGICAL AURORA,272,RC,,,,,,both,54.16,37.91,,,,,,,,,,,,,,,,,,,Other,11.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.68,11.68, DNO PACK EENT I,272,RC,,,,,,both,40.91,28.64,,,,,,,,,,,,,,,,,,,Other,8.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.82,8.82, PACK LAP 111,272,RC,,,,,,both,32.94,23.06,,,,,,,,,,,,,,,,,,,Other,7.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.1,7.1, CATH PERCUTANEOUS 14 FR,272,RC,,,,,,both,284.38,199.07,,,,,,,,,,,,,,,,,,,Other,61.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.31,61.31, CATH BENTSON WIRE .035X180 CM TSFB 35,C1769,HCPCS,272,RC,,,,both,82,57.4,,,,,,,,,,,,,,,,,,,Other,17.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.68,17.68, TUBE ENDOTRACHEAL 8.5,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, TUBE NASOPHARYNGEAL 28,272,RC,,,,,,both,49.6,34.72,,,,,,,,,,,,,,,,,,,Other,10.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.69,10.69, DNO TUBE COMBITUBE 41FR.,272,RC,,,,,,both,183.11,128.18,,,,,,,,,,,,,,,,,,,Other,39.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.47,39.47, DNO TUBE TRACH MLT 6.0,272,RC,,,,,,both,43.33,30.33,,,,,,,,,,,,,,,,,,,Other,9.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.34,9.34, DNO TUBE TRACH MLT 4.0,272,RC,,,,,,both,27.92,19.54,,,,,,,,,,,,,,,,,,,Other,6.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.02,6.02, ENDO TUBE 6.5MM ORAL RAE CUFFED,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, TUBE NASOPHARYNGEAL 26 FR,272,RC,,,,,,both,22.75,15.93,,,,,,,,,,,,,,,,,,,Other,4.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.91,4.91, ENDO TUBE NASAL RAE-FLEX 7.0,272,RC,,,,,,both,24,16.8,,,,,,,,,,,,,,,,,,,Other,5.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.17,5.17, ENDO TUBE NASAL RAE-FLEX 7.5,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, ENDO TUBE ORAL RAE FLEX CUFFED 7.5,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, TUBE NASOPHARYNGEAL 24FR,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, DNO TUBE TRACH ORAL RAE FLEX CUFFED 8.0,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO TUBE TRACH CUFFED 4.5,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO TUBE NASAL RAE NR W/O CUFF 4.0,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO TUBE NASAL RAE NR W/O CUFF 4.5,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO TUBE NASAL RAE NR W/O CUFF 5.5,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO ENDO TUBE 4.0 REIN O/N W/ CUFF,272,RC,,,,,,both,92.89,65.02,,,,,,,,,,,,,,,,,,,Other,20.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.03,20.03, ENDO TUBE 4.5 HI-LO CUFFED ORAL/NASAL,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, NEEDLE BIOPSY TRU-CUT,272,RC,,,,,,both,51.63,36.14,,,,,,,,,,,,,,,,,,,Other,11.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.13,11.13, NEEDLE CO-AX INTRODUCER 15G X11.8,272,RC,,,,,,both,150.86,105.6,,,,,,,,,,,,,,,,,,,Other,32.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.53,32.53, NEEDLE TIP SINGLE USE,272,RC,,,,,,both,234.03,163.82,,,,,,,,,,,,,,,,,,,Other,50.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.46,50.46, DNO ADHESIVE MASTISOL LIQUID 2/3 CC VIAL,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, MASK AEROSOL ADULT,71,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, TLAB TRANSJUGULAR LIVER BIOPSY KIT,272,RC,,,,,,both,1843.9,1290.73,,,,,,,,,,,,,,,,,,,Other,397.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,397.55,397.55, NEEDLE CHIBA 22GX20CM TENMO,272,RC,,,,,,both,22.35,15.65,,,,,,,,,,,,,,,,,,,Other,4.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.82,4.82, CATH 4 FR SIM1 NON-HYDROPHILLIC,272,RC,,,,,,both,55.97,39.18,,,,,,,,,,,,,,,,,,,Other,12.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.06,12.06, NEEDLE COAXIAL INTRO 19X10,272,RC,,,,,,both,80.99,56.69,,,,,,,,,,,,,,,,,,,Other,17.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.46,17.46, NEEDLE COAXIAL INTRO 19X15,272,RC,,,,,,both,80.99,56.69,,,,,,,,,,,,,,,,,,,Other,17.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.46,17.46, BIOPSY DEVICE 18G X 15CM,272,RC,,,,,,both,319.68,223.78,,,,,,,,,,,,,,,,,,,Other,68.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.92,68.92, BIOPSY NEEDLE CO-AX INTRO 17G X 11.8CM,272,RC,,,,,,both,150.88,105.62,,,,,,,,,,,,,,,,,,,Other,32.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.53,32.53, PUNCH BIOPSY 2MM,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, PUNCH BIOPSY 3MM,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, TRAY BONE MARROW BIOPSY JAMSHIDI,272,RC,,,,,,both,116.85,81.8,,,,,,,,,,,,,,,,,,,Other,25.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.2,25.2, COAXIAL SETS WITH CHIBA NEEDLE 14CM,272,RC,,,,,,both,160.22,112.15,,,,,,,,,,,,,,,,,,,Other,34.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.54,34.54, PLUG FISTULA ANAL,272,RC,,,,,,both,3968.76,2778.13,,,,,,,,,,,,,,,,,,,Other,855.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,855.67,855.67, BIOPSY DEVICE 16G X 15CM,272,RC,,,,,,both,319.68,223.78,,,,,,,,,,,,,,,,,,,Other,68.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.92,68.92, BIOPSY ACHIEVE 20X15,272,RC,,,,,,both,117.57,82.3,,,,,,,,,,,,,,,,,,,Other,25.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.35,25.35, PUNCH AORTIC CLEANCUT 3.5MM,272,RC,,,,,,both,80.17,56.12,,,,,,,,,,,,,,,,,,,Other,17.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.29,17.29, PUNCH AORTIC CLEANCUT 5.0MM,272,RC,,,,,,both,94.44,66.11,,,,,,,,,,,,,,,,,,,Other,20.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.36,20.36, AMPLATZER VASCULAR PLUG II 10MM,272,RC,,,,,,both,2922.13,2045.49,,,,,,,,,,,,,,,,,,,Other,630.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,630.01,630.01, AMPLATZER VASCULAR PLUG 4 4MM,272,RC,,,,,,both,3163.5,2214.45,,,,,,,,,,,,,,,,,,,Other,682.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,682.05,682.05, AMPLATZER VASCULAR PLUG 4 6MM,272,RC,,,,,,both,3336.57,2335.6,,,,,,,,,,,,,,,,,,,Other,719.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,719.37,719.37, AMPLATZER VASCULAR PLUG 4 8MM,272,RC,,,,,,both,3336.57,2335.6,,,,,,,,,,,,,,,,,,,Other,719.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,719.37,719.37, CATH W/GLOVE 14 SCTN,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, AMPLATZER VASCULAR PLUG 4 5MM,272,RC,,,,,,both,3163.5,2214.45,,,,,,,,,,,,,,,,,,,Other,682.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,682.05,682.05, AMPLATZER VASCULAR PLUG 4 7MM,272,RC,,,,,,both,3163.5,2214.45,,,,,,,,,,,,,,,,,,,Other,682.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,682.05,682.05, CATH SUCTION #10,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, CATH SUCTION 6 FR,A4624,HCPCS,272,RC,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, CATH 4 FR JB 1 TEMP OPEN END,272,RC,,,,,,both,69.03,48.32,,,,,,,,,,,,,,,,,,,Other,14.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.89,14.89, CATH BARD 14FR RED RUBBER COUDE,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, CATH VERSI 18FR,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, CATH COUDE 14FR 10CC - 5CC PACKAGE,A4340,HCPCS,272,RC,,,,both,39.66,27.76,,,,,,,,,,,,,,,,,,,Other,8.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.56,8.56, CATH MALECOT 22FR,272,RC,,,,,,both,108.54,75.98,,,,,,,,,,,,,,,,,,,Other,23.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.4,23.4, CATH MALECOT 24FR,272,RC,,,,,,both,82.61,57.83,,,,,,,,,,,,,,,,,,,Other,17.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.81,17.81, CATH MALECOT 24FR LATEX FREE,C1729,HCPCS,272,RC,,,,both,167.44,117.21,,,,,,,,,,,,,,,,,,,Other,36.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.1,36.1, DNO TUBE ET REINFORCED NO CUFF 3.0,272,RC,,,,,,both,127.44,89.21,,,,,,,,,,,,,,,,,,,Other,27.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,27.48,27.48, DNO TUBE ET REINFORCED NO CUFF 4.0,272,RC,,,,,,both,127.44,89.21,,,,,,,,,,,,,,,,,,,Other,27.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,27.48,27.48, DNO TUBE ET REINFORCED NO CUFF 4.5,272,RC,,,,,,both,125.15,87.61,,,,,,,,,,,,,,,,,,,Other,26.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.98,26.98, ENDO TUBE 8.0 ORAL RAE W/ CUFF,272,RC,,,,,,both,96.48,67.54,,,,,,,,,,,,,,,,,,,Other,20.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.81,20.81, ENDO TUBE NASAL RAE W/CUFF 8.0,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, TUBE ET REINFORCED W/CUFF 6.0,272,RC,,,,,,both,162,113.4,,,,,,,,,,,,,,,,,,,Other,34.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.93,34.93, DNO CATH BAKER JEJUNOSTOMY 16 F,272,RC,,,,,,both,1219.85,853.9,,,,,,,,,,,,,,,,,,,Other,263,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,263,263, KIT GASTROJEJUNOSTOMY SET,272,RC,,,,,,both,1423.2,996.24,,,,,,,,,,,,,,,,,,,Other,306.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,306.84,306.84, DNO CAUTERY TIP SURGICAL,272,RC,,,,,,both,26.24,18.37,,,,,,,,,,,,,,,,,,,Other,5.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.65,5.65, MARKER BREAST BIOPSY 17G. 10CM ULTRA CLI,A4648,HCPCS,278,RC,,,,both,245.08,171.56,,,,,,,,,,,,,,,,,,,Other,52.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,52.84,52.84, TIP SCISSOR METZENBAUM,272,RC,,,,,,both,224.3,157.01,,,,,,,,,,,,,,,,,,,Other,48.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,48.36,48.36, BAG COLOSTOMY FLANGE 2 3/4 70MM,271,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, PASTE KARAYA 7910,A4405,HCPCS,270,RC,,,,both,22.62,15.83,,,,,,,,,,,,,,,,,,,Other,4.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.88,4.88, "BAG OSTOMY 2"" DRAINABLE",272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, FLANGE FLEXWARE 2 3/4X 2 1/4,271,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, BARRIER POST OP CUT TO FIT,272,RC,,,,,,both,35.5,24.85,,,,,,,,,,,,,,,,,,,Other,7.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.65,7.65, BARRIER POST OP CUT TO FIT,A6154,HCPCS,272,RC,,,,both,54.43,38.1,,,,,,,,,,,,,,,,,,,Other,11.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.73,11.73, DX-PH PROBE,A4338,HCPCS,272,RC,,,,both,439.02,307.31,,,,,,,,,,,,,,,,,,,Other,94.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,94.65,94.65, DRESSING EZ DERM 3X4 (MEDISKIN),272,RC,,,,,,both,206.31,144.42,,,,,,,,,,,,,,,,,,,Other,44.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.48,44.48, ENDO TUBE 6.0MM HI-LO CUFFED ORAL/NASAL,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, DNO TUBE ET ORAL RAE NO CUFF 3.5,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, ENDO TUBE 3.5MM HI-LO CUFFED ORAL/NASAL,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, "DNO SET T-U-R ""Y"" TYPE IR",272,RC,,,,,,both,46.23,32.36,,,,,,,,,,,,,,,,,,,Other,9.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.97,9.97, SILICONE TUBE SALEM SUMP 10FRX36,272,RC,,,,,,both,61.27,42.89,,,,,,,,,,,,,,,,,,,Other,13.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.21,13.21, "SET CYSTO IRRIGATION 81"" (BAXTER)",272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, "SET TUR Y TYPE W/SIGHT CHAMBER 82""",272,RC,,,,,,both,31.98,22.39,,,,,,,,,,,,,,,,,,,Other,6.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.9,6.9, MAXCORE BIOPSY 18GX25CM,272,RC,,,,,,both,123,86.1,,,,,,,,,,,,,,,,,,,Other,26.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.52,26.52, ENDO GIA PURPLE 60MM MED/THICK RELOAD,272,RC,,,,,,both,936.46,655.52,,,,,,,,,,,,,,,,,,,Other,201.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,201.9,201.9, ENDO GIA BLCK 60MM RELOAD,272,RC,,,,,,both,1178.09,824.66,,,,,,,,,,,,,,,,,,,Other,254,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,254,254, NEEDLE KOPANS BREAST 20G/9CM,272,RC,,,,,,both,101.9,71.33,,,,,,,,,,,,,,,,,,,Other,21.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,21.97,21.97, NEEDLE BREAST KOPANS 20GA/9CM,272,RC,,,,,,both,75.35,52.75,,,,,,,,,,,,,,,,,,,Other,16.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.25,16.25, DNO CAUTERY PENCIL MEDLINE DISPOSABLE,272,RC,,,,,,both,24.3,17.01,,,,,,,,,,,,,,,,,,,Other,5.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.24,5.24, STAPLER ENDO GIA UNIVERSAL,272,RC,,,,,,both,428.47,299.93,,,,,,,,,,,,,,,,,,,Other,92.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,92.37,92.37, TUBE ET 7.5MM,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, ENDO TUBE NASAL RAE W/CUFF 6.0,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, ENDO TUBE NASAL RAE W/CUFF 6.5,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, DNO ENDO TUBE 7.0 REINFORCED W/CUFF,272,RC,,,,,,both,97.51,68.26,,,,,,,,,,,,,,,,,,,Other,21.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,21.02,21.02, TUBE TRACH LARYNGOFLEX SZ 10,272,RC,,,,,,both,271.78,190.25,,,,,,,,,,,,,,,,,,,Other,58.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,58.59,58.59, ENDO TUBE 6.5 HI-LO CUFED ORAL/NASAL,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO TUBE ENDOTRACHEAL 7.0,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO TUBE ENDOTRACHEAL 7.5MM,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO TUBE ENDOTRACHEAL 8.0MM,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, ENDO TUBE 9.0MM HI-LO CUFFED,272,RC,,,,,,both,4.35,3.05,,,,,,,,,,,,,,,,,,,Other,0.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.94,0.94, DNO TUBE ENDOTRACHEAL 9.5MM,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, ENDO TUBE 7.5 HI-LO CUFFED ORAL/NASAL,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, TUBE TRACH 7.0 HI-LO CUFFED,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, ENDO TUBE 8.0 HI-LO CUFFED,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, ENDO TUBE 5.5 HI-LO CUFFED ORAL/NASAL,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO TUBE TRACH LO-PRO CUFFED 6.0,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO TUBE TRACH CUFFED 8.0,272,RC,,,,,,both,38.83,27.18,,,,,,,,,,,,,,,,,,,Other,8.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.37,8.37, DNO TUBE TRACH CUFFED 8.5,272,RC,,,,,,both,38.79,27.15,,,,,,,,,,,,,,,,,,,Other,8.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.36,8.36, DNO TUBE TRACH CUFFED,272,RC,,,,,,both,27.16,19.01,,,,,,,,,,,,,,,,,,,Other,5.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.86,5.86, DNO ENDO TUBE 7.5 REINFORCED W/ CUFF,272,RC,,,,,,both,98.5,68.95,,,,,,,,,,,,,,,,,,,Other,21.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,21.24,21.24, DNO ENDO TUBE 8.0 REINFORCED W/ CUFF,272,RC,,,,,,both,95.74,67.02,,,,,,,,,,,,,,,,,,,Other,20.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.64,20.64, ENDO TUBE ORAL RAE CUFFED 5.5,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, ENDO TUBE 6.0MM ORAL RAE CUFFED,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, ENDO TUBE 5.0 HI-LO CUFFED ORAL/NASAL,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, CATH VISTA BRIGHT TIP 6FX55CM H-STICK,C1887,HCPCS,278,RC,,,,both,193.37,135.36,,,,,,,,,,,,,,,,,,,Other,41.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.69,41.69, CATH VISTA BRITE TIP 6F INTERNAL MAMMARY,C1887,HCPCS,278,RC,,,,both,678.2,474.74,,,,,,,,,,,,,,,,,,,Other,146.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,146.22,146.22, ENDO TUBE 7.0MM ORAL RAE CUFFED,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, DNO ENDO TUBE 5.5 LO-MAGILL CUFF,272,RC,,,,,,both,102.41,71.69,,,,,,,,,,,,,,,,,,,Other,22.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.08,22.08, "CAST STOCKINETTE 3"" X25YD",71,RC,,,,,,both,29.18,20.43,,,,,,,,,,,,,,,,,,,Other,6.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.29,6.29, DNO TUBE ET NO CUFF 4.0,C1725,HCPCS,272,RC,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, DNO TUBE ET W/CUFF 5.0,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO SET CYSTO IRRIGATION,272,RC,,,,,,both,39.76,27.83,,,,,,,,,,,,,,,,,,,Other,8.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.58,8.58, PVC TUBE SALEM SUMP 16FRX48 DBL LUMEN,B4082,HCPCS,274,RC,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SILICONE TUBE SALEM SUMP 18FR,272,RC,,,,,,both,61.27,42.89,,,,,,,,,,,,,,,,,,,Other,13.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.21,13.21, PVC TUBE SALEM SUMP 18FRX48 DBL LUMEN,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SILICONE TUBE SALEM SUMP 16FRX48,272,RC,,,,,,both,57.89,40.52,,,,,,,,,,,,,,,,,,,Other,12.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.49,12.49, PVC TUBE SALEM SUMP 14FRX48 DBL LUMEN,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, PVC TUBE SALEM SUMP 12FRX48,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DRYSEAL SHEATH DSL1628,C1894,HCPCS,278,RC,,,,both,915.74,641.02,,,,,,,,,,,,,,,,,,,Other,197.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,197.43,197.43, EXCLUDER RLT261418,C1874,HCPCS,278,RC,,,,both,37728.33,26409.83,,,,,,,,,,,,,,,,,,,Other,8134.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8134.23,8134.23, EXCLUDER PLC181400,C1874,HCPCS,278,RC,,,,both,15018.07,10512.65,,,,,,,,,,,,,,,,,,,Other,3237.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3237.9,3237.9, DRYSEAL SHEATH DSL1828,C1894,HCPCS,278,RC,,,,both,1098.88,769.22,,,,,,,,,,,,,,,,,,,Other,236.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,236.92,236.92, Q50 PLUS STENT GRAFT BALLOON CATH,C1725,HCPCS,278,RC,,,,both,1615.03,1130.52,,,,,,,,,,,,,,,,,,,Other,348.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,348.2,348.2, DRYSEAL SHEATH DSL1228,C1894,HCPCS,278,RC,,,,both,915.74,641.02,,,,,,,,,,,,,,,,,,,Other,197.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,197.43,197.43, EXCLUDER RLT281418,C1874,HCPCS,278,RC,,,,both,37728.33,26409.83,,,,,,,,,,,,,,,,,,,Other,8134.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8134.23,8134.23, SHEATH 5FR BRITE TIP,272,RC,,,,,,both,151.36,105.95,,,,,,,,,,,,,,,,,,,Other,32.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.63,32.63, 8 FR DESTINATION SHEATH,C1887,HCPCS,278,RC,,,,both,586.08,410.26,,,,,,,,,,,,,,,,,,,Other,126.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,126.36,126.36, SHEATH,272,RC,,,,,,both,456.58,319.61,,,,,,,,,,,,,,,,,,,Other,98.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,98.44,98.44, SHEATH,272,RC,,,,,,both,456.58,319.61,,,,,,,,,,,,,,,,,,,Other,98.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,98.44,98.44, SHEATH INTRODUCER 6FR SHUTTLE,272,RC,,,,,,both,828.88,580.22,,,,,,,,,,,,,,,,,,,Other,178.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,178.7,178.7, SHEATH DESTINATION 90CM,272,RC,,,,,,both,579.51,405.66,,,,,,,,,,,,,,,,,,,Other,124.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,124.94,124.94, DNO HEMOSTATIC ABSORBABLE PARTICLES,C1052,HCPCS,272,RC,,,,both,516.14,361.3,,,,,,,,,,,,,,,,,,,Other,111.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,111.28,111.28, SHEATH DESTINATION 45CM,272,RC,,,,,,both,616.05,431.24,,,,,,,,,,,,,,,,,,,Other,132.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,132.82,132.82, GRAFT MAIN BODY,C1768,HCPCS,278,RC,,,,both,28004.71,19603.3,,,,,,,,,,,,,,,,,,,Other,6037.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6037.82,6037.82, GRAFT LEG CONTROL,C1768,HCPCS,278,RC,,,,both,12553.91,8787.74,,,,,,,,,,,,,,,,,,,Other,2706.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2706.62,2706.62, DISC ENDO FAN RETRACT 10MM,272,RC,,,,,,both,761.12,532.78,,,,,,,,,,,,,,,,,,,Other,164.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,164.1,164.1, DISC GRASPER ROTICULATOR 5MM,272,RC,,,,,,both,919.64,643.75,,,,,,,,,,,,,,,,,,,Other,198.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,198.27,198.27, SILS DISSECTOR 5MM,272,RC,,,,,,both,1131.62,792.13,,,,,,,,,,,,,,,,,,,Other,243.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,243.98,243.98, SHEATH DESTINATION RDC RENAL CATH 6FR 45,272,RC,,,,,,both,586.08,410.26,,,,,,,,,,,,,,,,,,,Other,126.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,126.36,126.36, MARGINMARKER WITH CLIPS,272,RC,,,,,,both,592.22,414.55,,,,,,,,,,,,,,,,,,,Other,127.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,127.68,127.68, SHEATH DESTINATION RDC RENAL 5FR 45CM,272,RC,,,,,,both,616.05,431.24,,,,,,,,,,,,,,,,,,,Other,132.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,132.82,132.82, ENDOPATH 5MM GRASPER,272,RC,,,,,,both,144.13,100.89,,,,,,,,,,,,,,,,,,,Other,31.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,31.08,31.08, DISC GRASPER DISSECTING 5MM,272,RC,,,,,,both,919.65,643.76,,,,,,,,,,,,,,,,,,,Other,198.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,198.27,198.27, *CATH EPIDURAL,272,RC,,,,,,both,52.24,36.57,,,,,,,,,,,,,,,,,,,Other,11.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.26,11.26, TROCAR THORACIC 12MM,272,RC,,,,,,both,265.67,185.97,,,,,,,,,,,,,,,,,,,Other,57.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,57.28,57.28, EXCLUDER RLT231218,C1874,HCPCS,278,RC,,,,both,36151.15,25305.81,,,,,,,,,,,,,,,,,,,Other,7794.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7794.18,7794.18, EXCLUDER PLC141200,C1874,HCPCS,278,RC,,,,both,14335.65,10034.96,,,,,,,,,,,,,,,,,,,Other,3090.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3090.76,3090.76, EXCLUDER PLL161207,C1874,HCPCS,278,RC,,,,both,10069.92,7048.94,,,,,,,,,,,,,,,,,,,Other,2171.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2171.07,2171.07, DRYSEAL SHEATH DSF1233,C1894,HCPCS,278,RC,,,,both,1471.86,1030.3,,,,,,,,,,,,,,,,,,,Other,317.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,317.33,317.33, DRYSEAL SHEATH DSF1633,C1894,HCPCS,278,RC,,,,both,1415.25,990.68,,,,,,,,,,,,,,,,,,,Other,305.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,305.13,305.13, PT CHG METER PEAK FLOW,A4614,HCPCS,270,RC,,,,both,31.48,22.04,,,,,,,,,,,,,,,,,,,Other,6.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.79,6.79, CATH OCCULDER OCCULSION MOLDING MOB37,C1725,HCPCS,272,RC,,,,both,1655.01,1158.51,,,,,,,,,,,,,,,,,,,Other,356.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,356.82,356.82, EXCLUDER PLL161407,C1874,HCPCS,278,RC,,,,both,10572.75,7400.93,,,,,,,,,,,,,,,,,,,Other,2279.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2279.49,2279.49, DNO TRAY PONSKY PULL PEG,272,RC,,,,,,both,208.61,146.03,,,,,,,,,,,,,,,,,,,Other,44.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.97,44.97, TISSUE EXPANDERS,278,RC,,,,,,both,4829.25,3380.48,,,,,,,,,,,,,,,,,,,Other,1041.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1041.19,1041.19, LIGASURE EXACT DISSECTOR,272,RC,,,,,,both,2190.58,1533.41,,,,,,,,,,,,,,,,,,,Other,472.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,472.29,472.29, LIGASURE IMPACT,272,RC,,,,,,both,1714.95,1200.47,,,,,,,,,,,,,,,,,,,Other,369.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,369.74,369.74, LIGASURE SMALL JAW,272,RC,,,,,,both,1231.63,862.14,,,,,,,,,,,,,,,,,,,Other,265.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,265.54,265.54, LIGASURE BLUNT TIP 5 MM,272,RC,,,,,,both,1896.57,1327.6,,,,,,,,,,,,,,,,,,,Other,408.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,408.9,408.9, DNO PENCIL FORCE TRIVERSE BOVIE,272,RC,,,,,,both,172.97,121.08,,,,,,,,,,,,,,,,,,,Other,37.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.29,37.29, LIGASURE ATLAS 10MM 37CM HAND SWITCHING,272,RC,,,,,,both,1633.24,1143.27,,,,,,,,,,,,,,,,,,,Other,352.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,352.12,352.12, LIGASURE CURVED MARYLAND 5MM 23CM,272,RC,,,,,,both,2184.47,1529.13,,,,,,,,,,,,,,,,,,,Other,470.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,470.97,470.97, LIGASURE CURVED MARYLAND 5MM 37CM,272,RC,,,,,,both,1492,1044.4,,,,,,,,,,,,,,,,,,,Other,321.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,321.68,321.68, DISC VISIPORT PLUS OPTICAL TROCAR 5-12MM,272,RC,,,,,,both,552.98,387.09,,,,,,,,,,,,,,,,,,,Other,119.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,119.23,119.23, REPROC LIGASURE CURVED MARYLAND 5MM 37CM,272,RC,,,,,,both,1315.35,920.75,,,,,,,,,,,,,,,,,,,Other,283.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,283.59,283.59, LIGASURE BLUNT TIP 37CM,272,RC,,,,,,both,1384.11,968.88,,,,,,,,,,,,,,,,,,,Other,298.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,298.41,298.41, "MEGADYNE ELECTRO BLADE 2.75"" PTFE-COATED",272,RC,,,,,,both,24.36,17.05,,,,,,,,,,,,,,,,,,,Other,5.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.25,5.25, ELECTRODE BLADE 6.5 E-Z CLEAN INSULATED,272,RC,,,,,,both,33.98,23.79,,,,,,,,,,,,,,,,,,,Other,7.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.33,7.33, CATH BERENSTEIN II .038 X 100 CM,272,RC,,,,,,both,52.02,36.41,,,,,,,,,,,,,,,,,,,Other,11.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.21,11.21, "MEGADYNE EZ CLEAN BLADE ELECTRODES 4""",272,RC,,,,,,both,35.96,25.17,,,,,,,,,,,,,,,,,,,Other,7.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.75,7.75, SCISSOR 5MMX35CM,272,RC,,,,,,both,164.32,115.02,,,,,,,,,,,,,,,,,,,Other,35.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.43,35.43, BAG SPECIMEN RETRIEVAL SYSTEM,272,RC,,,,,,both,119.88,83.92,,,,,,,,,,,,,,,,,,,Other,25.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.84,25.84, TROCAR BALLOON 12X100MM,272,RC,,,,,,both,88.15,61.71,,,,,,,,,,,,,,,,,,,Other,19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19,19, TROCAR 5X100 OPT SEP SYS,272,RC,,,,,,both,76.01,53.21,,,,,,,,,,,,,,,,,,,Other,16.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.39,16.39, SLEEVE CANN/SEAL,272,RC,,,,,,both,28.95,20.27,,,,,,,,,,,,,,,,,,,Other,6.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.24,6.24, SLEEVE 11X100MM THR CAN/SEAL,272,RC,,,,,,both,61.24,42.87,,,,,,,,,,,,,,,,,,,Other,13.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.2,13.2, TROCAR 15X150 NON BLADED,272,RC,,,,,,both,200.59,140.41,,,,,,,,,,,,,,,,,,,Other,43.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.25,43.25, DNO CAUTERY PENCIL,271,RC,,,,,,both,53.45,37.42,,,,,,,,,,,,,,,,,,,Other,11.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.52,11.52, DNO BLADE ELECTRODE,272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, "NEEDLE MEGADYNE NEEDLE ELECTRODE 2.75""",272,RC,,,,,,both,27.35,19.15,,,,,,,,,,,,,,,,,,,Other,5.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.9,5.9, "E-Z CLEAN BLADE ELECTRODE 6""",272,RC,,,,,,both,30.87,21.61,,,,,,,,,,,,,,,,,,,Other,6.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.65,6.65, KII FIOS FIRST ENTRY 5MM X 150MM,272,RC,,,,,,both,73.49,51.44,,,,,,,,,,,,,,,,,,,Other,15.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.85,15.85, KII SLEEVE 11 X 150,272,RC,,,,,,both,55.67,38.97,,,,,,,,,,,,,,,,,,,Other,12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12,12, DNO TROCAR 15X100MM OPTICAL ACCESS,272,RC,,,,,,both,162.93,114.05,,,,,,,,,,,,,,,,,,,Other,35.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.12,35.12, TROCAR 5X100MM OPTIC ACCESS,272,RC,,,,,,both,76.01,53.21,,,,,,,,,,,,,,,,,,,Other,16.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.39,16.39, CLIP APPLIER AUTO ENDO 5MM,272,RC,,,,,,both,470.28,329.2,,,,,,,,,,,,,,,,,,,Other,101.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,101.39,101.39, TROCAR 5x100 NO BALLOON,272,RC,,,,,,both,77.94,54.56,,,,,,,,,,,,,,,,,,,Other,16.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.81,16.81, DNO TROCAR 5x150,272,RC,,,,,,both,76.01,53.21,,,,,,,,,,,,,,,,,,,Other,16.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.39,16.39, TROCAR SLEEVE 5 X 100MM,272,RC,,,,,,both,33.83,23.68,,,,,,,,,,,,,,,,,,,Other,7.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.29,7.29, ACCESS NEEDLE STEP INSUFFLATION,272,RC,,,,,,both,165.39,115.77,,,,,,,,,,,,,,,,,,,Other,35.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.66,35.66, "NEEDLE, SURGINEEDLE 150MM LONG PNEUMOPER",272,RC,,,,,,both,75.16,52.61,,,,,,,,,,,,,,,,,,,Other,16.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.21,16.21, DNO SPECIMEN RETRIEVAL SYSTEM 3X6,272,RC,,,,,,both,191.4,133.98,,,,,,,,,,,,,,,,,,,Other,41.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.27,41.27, DNO ENDOSCOPIC PEANUT DEVICE 5MM,272,RC,,,,,,both,213.67,149.57,,,,,,,,,,,,,,,,,,,Other,46.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,46.07,46.07, TROCAR OPTIC PORT 11x100MM,272,RC,,,,,,both,88.15,61.71,,,,,,,,,,,,,,,,,,,Other,19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19,19, OPTICAL PORT SLEEVE 11 X 100,272,RC,,,,,,both,58.07,40.65,,,,,,,,,,,,,,,,,,,Other,12.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.52,12.52, CLIP APPLIER 5MM ENDOCLIP III,272,RC,,,,,,both,548.95,384.27,,,,,,,,,,,,,,,,,,,Other,118.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,118.35,118.35, CLIP APPLIER 10MM ENDOCLIP II,272,RC,,,,,,both,336.51,235.56,,,,,,,,,,,,,,,,,,,Other,72.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,72.55,72.55, DRAIN ROUND WOUND W/ TROCAR 10FR,272,RC,,,,,,both,35.71,25,,,,,,,,,,,,,,,,,,,Other,7.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.7,7.7, 12X150 KII OPTICAL ACCESS SYSTEM,272,RC,,,,,,both,118.24,82.77,,,,,,,,,,,,,,,,,,,Other,25.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.49,25.49, CATH OCCULDER OCCULISION 26FRX100CM,C1725,HCPCS,272,RC,,,,both,847.19,593.03,,,,,,,,,,,,,,,,,,,Other,182.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,182.65,182.65, CATH OCCULDER OCCULSION 34FRX100CM,C1725,HCPCS,272,RC,,,,both,847.19,593.03,,,,,,,,,,,,,,,,,,,Other,182.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,182.65,182.65, DNO LINEAR RELOAD 60MM GREEN,272,RC,,,,,,both,538.66,377.06,,,,,,,,,,,,,,,,,,,Other,116.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,116.14,116.14, STAPLER ETHELON POWERED 60MM,272,RC,,,,,,both,2327.41,1629.19,,,,,,,,,,,,,,,,,,,Other,501.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,501.79,501.79, REINFORCEMENT ECHELON 60MM,272,RC,,,,,,both,757.54,530.28,,,,,,,,,,,,,,,,,,,Other,163.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,163.33,163.33, "PUSH-BUTTON SMOKE EVAC PENCIL, COATED",272,RC,,,,,,both,97.13,67.99,,,,,,,,,,,,,,,,,,,Other,20.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.94,20.94, CATH ART EMB 2FR,272,RC,,,,,,both,332.77,232.94,,,,,,,,,,,,,,,,,,,Other,71.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.75,71.75, TRAY SPINAL PENCIL PO W/O LIDOCAINE,272,RC,,,,,,both,44.84,31.39,,,,,,,,,,,,,,,,,,,Other,9.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.66,9.66, DNO TRAY LUMBAR PUNCTURE PED,272,RC,,,,,,both,64,44.8,,,,,,,,,,,,,,,,,,,Other,13.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.8,13.8, CONV RELOAD LINEAR CUTTER 55MM,272,RC,,,,,,both,158.36,110.85,,,,,,,,,,,,,,,,,,,Other,34.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.14,34.14, TRAY EPIDURAL PAINPAK,272,RC,,,,,,both,56.23,39.36,,,,,,,,,,,,,,,,,,,Other,12.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.12,12.12, TRAY SPINAL PENCIL LIDOCAINE,272,RC,,,,,,both,64.35,45.05,,,,,,,,,,,,,,,,,,,Other,13.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.88,13.88, TRAY CONTINOUS EPIDURAL CATH & LIDOCAINE,272,RC,,,,,,both,96.1,67.27,,,,,,,,,,,,,,,,,,,Other,20.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.72,20.72, TRAY LUMBAR PUNCTURE,272,RC,,,,,,both,74.46,52.12,,,,,,,,,,,,,,,,,,,Other,16.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.05,16.05, TRAY CONTINOUS CONTINUOUS EPIDURAL TRAY,272,RC,,,,,,both,80.48,56.34,,,,,,,,,,,,,,,,,,,Other,17.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.36,17.36, DNO TRAY THORACENTISIS,272,RC,,,,,,both,142.86,100,,,,,,,,,,,,,,,,,,,Other,30.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,30.8,30.8, TRAY SPINAL NEEDLE PEACAN,272,RC,,,,,,both,78.17,54.72,,,,,,,,,,,,,,,,,,,Other,16.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.86,16.86, DNO SET NERVE BLOCK CONT TUOHY,272,RC,,,,,,both,127.39,89.17,,,,,,,,,,,,,,,,,,,Other,27.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,27.47,27.47, SET NERVE BLOCK CONT TUOHY,272,RC,,,,,,both,111.93,78.35,,,,,,,,,,,,,,,,,,,Other,24.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.13,24.13, TRAY NERVE BLOCK CONT STIM,272,RC,,,,,,both,326.65,228.66,,,,,,,,,,,,,,,,,,,Other,70.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,70.42,70.42, SET NERVE BLOCK CONT TUOHY,272,RC,,,,,,both,111.97,78.38,,,,,,,,,,,,,,,,,,,Other,24.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.14,24.14, SHEATH SUPER R/O 8FR 11CM,272,RC,,,,,,both,160.35,112.25,,,,,,,,,,,,,,,,,,,Other,34.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.57,34.57, DNO TIPLESS STONE EXTRACTOR,272,RC,,,,,,both,1202.13,841.49,,,,,,,,,,,,,,,,,,,Other,259.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,259.18,259.18, EXTRACTOR EBL 8.5-20,272,RC,,,,,,both,621.65,435.16,,,,,,,,,,,,,,,,,,,Other,134.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,134.02,134.02, EXTRACTOR STONE EBL,272,RC,,,,,,both,511.02,357.71,,,,,,,,,,,,,,,,,,,Other,110.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,110.17,110.17, WIRE BASKET MWB-2X4,272,RC,,,,,,both,1450.53,1015.37,,,,,,,,,,,,,,,,,,,Other,312.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,312.74,312.74, BASKET MEMORY POLYP RETRIEVER 7FR,272,RC,,,,,,both,636.03,445.22,,,,,,,,,,,,,,,,,,,Other,137.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,137.13,137.13, ENDOSCOPIC KITTNER 5MM 40CM DISSECTOR,272,RC,,,,,,both,22.7,15.89,,,,,,,,,,,,,,,,,,,Other,4.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.89,4.89, DNO BLADE BEAVER 3M,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO BLADE BEAVER 5MM,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO ENDOPATH ENDOSCOPIC DISSECTOR 5MM,272,RC,,,,,,both,71.65,50.16,,,,,,,,,,,,,,,,,,,Other,15.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.44,15.44, STYLET INTUBATING 14FR,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, STYLET INTUBATING 10FR,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, BASKET RETRIEVER ZERO TIP,272,RC,,,,,,both,729.97,510.98,,,,,,,,,,,,,,,,,,,Other,157.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,157.38,157.38, BASKET STONE RETRACTOR TIPLESS 1.5FR,272,RC,,,,,,both,1018.34,712.84,,,,,,,,,,,,,,,,,,,Other,219.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,219.55,219.55, BASKET STONE SKYLITE TIPLESS 1.9FR,272,RC,,,,,,both,822.38,575.67,,,,,,,,,,,,,,,,,,,Other,177.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,177.3,177.3, DNO STAPLER ETHELON POWERED 440MM,272,RC,,,,,,both,1122.92,786.04,,,,,,,,,,,,,,,,,,,Other,242.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,242.1,242.1, DNO LINEAR RELOAD 60MM BLUE,272,RC,,,,,,both,820.17,574.12,,,,,,,,,,,,,,,,,,,Other,176.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,176.83,176.83, DNO LINEAR RELOAD 60MM BLACK,272,RC,,,,,,both,820.17,574.12,,,,,,,,,,,,,,,,,,,Other,176.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,176.83,176.83, "ULTRABLATOR 30 DEGREE, THREE RIB",272,RC,,,,,,both,285.12,199.58,,,,,,,,,,,,,,,,,,,Other,61.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.48,61.48, "ULTRABLATOR 90 DEGREE, THREE RIB",272,RC,,,,,,both,285.12,199.58,,,,,,,,,,,,,,,,,,,Other,61.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.48,61.48, STENT 4.8FRX24CM URET,C1874,HCPCS,278,RC,,,,both,695.96,487.17,,,,,,,,,,,,,,,,,,,Other,150.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,150.05,150.05, STENT 4.BFR 26 CM URET,C1874,HCPCS,278,RC,,,,both,695.96,487.17,,,,,,,,,,,,,,,,,,,Other,150.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,150.05,150.05, 7x26 CONTOUR URETERAL STENT,C1874,HCPCS,278,RC,,,,both,368.23,257.76,,,,,,,,,,,,,,,,,,,Other,79.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,79.39,79.39, STENT 7FR X 24CM URETERAL SOFT,C1874,HCPCS,278,RC,,,,both,492.37,344.66,,,,,,,,,,,,,,,,,,,Other,106.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,106.15,106.15, CATH 18FR X 4CM URETERAL BALLOON,272,RC,,,,,,both,892.61,624.83,,,,,,,,,,,,,,,,,,,Other,192.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,192.44,192.44, STENT CAROTID 6MMX30MM,C1874,HCPCS,278,RC,,,,both,7325.89,5128.12,,,,,,,,,,,,,,,,,,,Other,1579.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1579.47,1579.47, STENT CAROTID 6MMX20MM,C1874,HCPCS,278,RC,,,,both,7325.89,5128.12,,,,,,,,,,,,,,,,,,,Other,1579.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1579.47,1579.47, STENT CAROTID 7MMX20MM,C1874,HCPCS,278,RC,,,,both,7325.89,5128.12,,,,,,,,,,,,,,,,,,,Other,1579.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1579.47,1579.47, PAPILLOTOME HUIBRESGS,272,RC,,,,,,both,846.43,592.5,,,,,,,,,,,,,,,,,,,Other,182.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,182.49,182.49, DNO SUCTION IRRIGATION KIT W/TUBING,272,RC,,,,,,both,156.69,109.68,,,,,,,,,,,,,,,,,,,Other,33.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,33.78,33.78, ENDOPATH PROBE SHAFT,272,RC,,,,,,both,112.77,78.94,,,,,,,,,,,,,,,,,,,Other,24.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.31,24.31, SUCTION IRRIGATOR HANDPIECE - ENDOPATH,272,RC,,,,,,both,175.15,122.61,,,,,,,,,,,,,,,,,,,Other,37.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.76,37.76, HOOK ENDOPATH ELECTRODE,272,RC,,,,,,both,112.77,78.94,,,,,,,,,,,,,,,,,,,Other,24.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.31,24.31, EPIX SUCTION IRRIGATOR SYSTEM W/5MM PROB,272,RC,,,,,,both,236.43,165.5,,,,,,,,,,,,,,,,,,,Other,50.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.97,50.97, TUBE NASOPHARYNGEAL 32,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, TUBE NASOPHARYNGEAL 30,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, VALVE TRACH/VENT SWALLOWING,272,RC,,,,,,both,235.49,164.84,,,,,,,,,,,,,,,,,,,Other,50.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.77,50.77, URINEMETER 400 ML BAG 2500 CC,A4357,HCPCS,272,RC,,,,both,25.89,18.12,,,,,,,,,,,,,,,,,,,Other,5.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.59,5.59, PACK ANGIO (CUSTOM),272,RC,,,,,,both,211.12,147.78,,,,,,,,,,,,,,,,,,,Other,45.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,45.52,45.52, SET MANOMETER W/STOPC,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, COIL EMBOLIZATION 5 X,272,RC,,,,,,both,188.75,132.13,,,,,,,,,,,,,,,,,,,Other,40.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.7,40.7, ENDO TUBE 3.0MM HI-LO CUFFED ORAL/NASAL,272,RC,,,,,,both,22.7,15.89,,,,,,,,,,,,,,,,,,,Other,4.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.89,4.89, ENDO TUBE ORAL RAE CUFFED 4.0,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO TUBE TRACH 2.5 UNCUFFED,272,RC,,,,,,both,112.13,78.49,,,,,,,,,,,,,,,,,,,Other,24.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.18,24.18, PH PROBE PAC-50015M,272,RC,,,,,,both,181.62,127.13,,,,,,,,,,,,,,,,,,,Other,39.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.16,39.16, ENDO TUBE 3.5MM ORAL RAE MICROCUFF PED,272,RC,,,,,,both,38.88,27.22,,,,,,,,,,,,,,,,,,,Other,8.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.38,8.38, DNO ENDO TUBE 4.0MM ORAL RAE CUFFED PED,272,RC,,,,,,both,82.68,57.88,,,,,,,,,,,,,,,,,,,Other,17.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.83,17.83, DNO ENDO TUBE ORAL RAE CUFFED 4.5,272,RC,,,,,,both,47.44,33.21,,,,,,,,,,,,,,,,,,,Other,10.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.23,10.23, DNO ENDO TUBE 5.0MM ORAL RAE CUFFED PED,272,RC,,,,,,both,36.43,25.5,,,,,,,,,,,,,,,,,,,Other,7.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.85,7.85, DNO ENDO TUBE 5.5 ORAL RAE CUFFED PED,272,RC,,,,,,both,47.44,33.21,,,,,,,,,,,,,,,,,,,Other,10.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.23,10.23, ENDO TUBE 4.0 HI-LO CUFFED ORAL/NASAL,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, INTRODUCER HEMOSTASIS 6FR 12CM,272,RC,,,,,,both,34.24,23.97,,,,,,,,,,,,,,,,,,,Other,7.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.38,7.38, INTRODUCER HEMOSTASIS 6FR 5CM,272,RC,,,,,,both,43.24,30.27,,,,,,,,,,,,,,,,,,,Other,9.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.32,9.32, NEEDLE ASPERATION 21G 13MM,272,RC,,,,,,both,242.32,169.62,,,,,,,,,,,,,,,,,,,Other,52.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,52.24,52.24, NEEDLE ASPERATION 21G W/PORT 13MM,272,RC,,,,,,both,272.93,191.05,,,,,,,,,,,,,,,,,,,Other,58.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,58.84,58.84, NEEDLE ASPIRATION NA2 SMOOTHSHOT 21G,272,RC,,,,,,both,272.93,191.05,,,,,,,,,,,,,,,,,,,Other,58.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,58.84,58.84, NEEDLE SPINAL 18 X 3 1/2,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO NEEDLE 22 X 3/4 NON-C,272,RC,,,,,,both,50.76,35.53,,,,,,,,,,,,,,,,,,,Other,10.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.95,10.95, TUBE UNIVENT ENDO 6.5,272,RC,,,,,,both,628.68,440.08,,,,,,,,,,,,,,,,,,,Other,135.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,135.54,135.54, DNO TUBE UNIVENT ENDO 7.5MM,272,RC,,,,,,both,628.68,440.08,,,,,,,,,,,,,,,,,,,Other,135.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,135.54,135.54, DNO TUBE UNIVENT ENDO 7.0MM,272,RC,,,,,,both,628.68,440.08,,,,,,,,,,,,,,,,,,,Other,135.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,135.54,135.54, TUBE UNIVENT ENDO 8.5,272,RC,,,,,,both,628.68,440.08,,,,,,,,,,,,,,,,,,,Other,135.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,135.54,135.54, TUBE UNIVENT ENDO 8.0,272,RC,,,,,,both,628.68,440.08,,,,,,,,,,,,,,,,,,,Other,135.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,135.54,135.54, NEEDLE SPINAL 22 X 3.5,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, DNO NEEDLE RIGHT ANGLE 20G X 1,272,RC,,,,,,both,30.75,21.53,,,,,,,,,,,,,,,,,,,Other,6.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.63,6.63, DNO NEEDLE 20 X 3/4 NDN-C,272,RC,,,,,,both,24.3,17.01,,,,,,,,,,,,,,,,,,,Other,5.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.24,5.24, DNO NEEDLE 22 X 1 NON-COR,272,RC,,,,,,both,52.32,36.62,,,,,,,,,,,,,,,,,,,Other,11.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.28,11.28, DNO NEEDLE 19 X 1.5 NON-CORING RT,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO NEEDLE 19 X 3/4 NDN-C,272,RC,,,,,,both,23.22,16.25,,,,,,,,,,,,,,,,,,,Other,5.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.01,5.01, GUIDE WIRE STEERABLE,C1769,HCPCS,278,RC,,,,both,466.19,326.33,,,,,,,,,,,,,,,,,,,Other,100.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,100.51,100.51, CANNULA 100MM 20G,272,RC,,,,,,both,186.44,130.51,,,,,,,,,,,,,,,,,,,Other,40.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.2,40.2, GROUNDING PAD RFA,272,RC,,,,,,both,105.47,73.83,,,,,,,,,,,,,,,,,,,Other,22.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.74,22.74, ALEXIS WOUND PROTECTOR/RETRACTOR X-LARG,272,RC,,,,,,both,229.77,160.84,,,,,,,,,,,,,,,,,,,Other,49.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,49.54,49.54, DNO ALEXIS WOUND PROTECT/RETRACTOR XX-LG,272,RC,,,,,,both,319.68,223.78,,,,,,,,,,,,,,,,,,,Other,68.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.92,68.92, ALEXIS WOUND PROTECTOR/RETRACTOR LARGE,272,RC,,,,,,both,183.15,128.21,,,,,,,,,,,,,,,,,,,Other,39.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.48,39.48, ALEXIS WOUND PROTECTOR/RETRACTOR MEDIU,272,RC,,,,,,both,131.2,91.84,,,,,,,,,,,,,,,,,,,Other,28.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28.28,28.28, STENT SMART 14X40,C1874,HCPCS,278,RC,,,,both,4706.72,3294.7,,,,,,,,,,,,,,,,,,,Other,1014.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1014.77,1014.77, STENT SMART 14X60,C1874,HCPCS,278,RC,,,,both,4706.72,3294.7,,,,,,,,,,,,,,,,,,,Other,1014.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1014.77,1014.77, SYRINGE EPIDURAL 7CC,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, LIGACLIP ALLPORT M/L,272,RC,,,,,,both,1948.22,1363.75,,,,,,,,,,,,,,,,,,,Other,420.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,420.04,420.04, BLADE BEAVER MINI,272,RC,,,,,,both,21.07,14.75,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, CATH ULTRA 5FR/120CM,272,RC,,,,,,both,948.3,663.81,,,,,,,,,,,,,,,,,,,Other,204.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,204.46,204.46, SHEATH 6FR 11C BRIGHT,C1874,HCPCS,278,RC,,,,both,51.25,35.88,,,,,,,,,,,,,,,,,,,Other,11.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.05,11.05, DNO NEEDLE SPINAL 22 X 8 INCH,270,RC,,,,,,both,64.87,45.41,,,,,,,,,,,,,,,,,,,Other,13.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.98,13.98, DNO NEEDLE SPINAL 20G X6IN LONG LENGTH,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO NEEDLE SPINAL 18G X 6IN LONG LENGTH,272,RC,,,,,,both,25.17,17.62,,,,,,,,,,,,,,,,,,,Other,5.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.43,5.43, DNO NEEDLE SPINAL 22X5,272,RC,,,,,,both,31.64,22.15,,,,,,,,,,,,,,,,,,,Other,6.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.82,6.82, DNO NEEDLE SPINAL 20X5,272,RC,,,,,,both,31.64,22.15,,,,,,,,,,,,,,,,,,,Other,6.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.82,6.82, NEEDLE SPINAL TUOHY 20GX6,272,RC,,,,,,both,27.55,19.29,,,,,,,,,,,,,,,,,,,Other,5.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.94,5.94, NEEDLE SPINAL TUOHY 22GX5,272,RC,,,,,,both,44.9,31.43,,,,,,,,,,,,,,,,,,,Other,9.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.68,9.68, BASKET STONE 2.4 FR GEMINI 3 WIRE,272,RC,,,,,,both,1045.74,732.02,,,,,,,,,,,,,,,,,,,Other,225.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,225.46,225.46, DNO SHEATH 7FR BRIGHT TIP 5.5CM,272,RC,,,,,,both,51.25,35.88,,,,,,,,,,,,,,,,,,,Other,11.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.05,11.05, SHEATH 7FR BRIGHT TI,272,RC,,,,,,both,137.21,96.05,,,,,,,,,,,,,,,,,,,Other,29.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,29.59,29.59, CATH PIGTAIL 4FR 110CM,C1887,HCPCS,272,RC,,,,both,46.9,32.83,,,,,,,,,,,,,,,,,,,Other,10.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.11,10.11, CATH PIGTAIL 4FR 65CM,C1887,HCPCS,272,RC,,,,both,46.74,32.72,,,,,,,,,,,,,,,,,,,Other,10.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.07,10.07, ACCU-VU PIGTAIL 4FX70CM,C1887,HCPCS,272,RC,,,,both,949.65,664.76,,,,,,,,,,,,,,,,,,,Other,204.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,204.74,204.74, GUIDEWIRE 0.035 X 300CM STORQ,C1769,HCPCS,272,RC,,,,both,216.78,151.75,,,,,,,,,,,,,,,,,,,Other,46.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,46.74,46.74, WIRE INFUSION KATZEN,272,RC,,,,,,both,705.95,494.17,,,,,,,,,,,,,,,,,,,Other,152.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,152.2,152.2, STENT WALL 20 X 40 CM,C1874,HCPCS,278,RC,,,,both,3979.29,2785.5,,,,,,,,,,,,,,,,,,,Other,857.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,857.93,857.93, VIABAHN VBX BALLOON EXPANDABLE ENDOPROST,C1874,HCPCS,278,RC,,,,both,10722.6,7505.82,,,,,,,,,,,,,,,,,,,Other,2311.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2311.79,2311.79, VIABAHN ENDOPROSTHESIS,C1874,HCPCS,278,RC,,,,both,10822.34,7575.64,,,,,,,,,,,,,,,,,,,Other,2333.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2333.29,2333.29, VIABAHN BALLOON EXPANDABLE ENDOPROSTHESI,C1874,HCPCS,278,RC,,,,both,10838.99,7587.29,,,,,,,,,,,,,,,,,,,Other,2336.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2336.89,2336.89, VIABAHN VBX BALLOON EXPANDABLE ENDOPROST,C1874,HCPCS,278,RC,,,,both,11108.71,7776.1,,,,,,,,,,,,,,,,,,,Other,2395.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2395.04,2395.04, DNO CATH GLIDE TERUMO 4FR 65 LONG,272,RC,,,,,,both,296.7,207.69,,,,,,,,,,,,,,,,,,,Other,63.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,63.96,63.96, CATH GLIDE TERUMO 120CM,272,RC,,,,,,both,242,169.4,,,,,,,,,,,,,,,,,,,Other,52.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,52.18,52.18, VIABAHN VBX BALLOON EXPANDABLE ENDOPROST,C1874,HCPCS,278,RC,,,,both,11108.71,7776.1,,,,,,,,,,,,,,,,,,,Other,2395.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2395.04,2395.04, VIABAHN VBX BALLOON EXPANDABLE ENDOPROST,C1874,HCPCS,278,RC,,,,both,10722.6,7505.82,,,,,,,,,,,,,,,,,,,Other,2311.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2311.79,2311.79, VIABAHN ENDOPROSTHESIS,C1874,HCPCS,278,RC,,,,both,23861.45,16703.02,,,,,,,,,,,,,,,,,,,Other,5144.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5144.53,5144.53, VIABAHN ENDOPROSTHESIS,C1874,HCPCS,278,RC,,,,both,11851.47,8296.03,,,,,,,,,,,,,,,,,,,Other,2555.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2555.17,2555.17, VIABAHN VBX BALLOON EXPANDABLE ENDOPROST,C1874,HCPCS,278,RC,,,,both,11385.27,7969.69,,,,,,,,,,,,,,,,,,,Other,2454.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2454.66,2454.66, VIABAHN ENDOPROSTHESIS,C1874,HCPCS,278,RC,,,,both,11388.6,7972.02,,,,,,,,,,,,,,,,,,,Other,2455.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2455.38,2455.38, VIABAHN ENDOPROSTHESIS,C1874,HCPCS,278,RC,,,,both,12297.69,8608.38,,,,,,,,,,,,,,,,,,,Other,2651.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2651.38,2651.38, VIABAHN ENDOPROSTHESIS,C1874,HCPCS,278,RC,,,,both,11142.18,7799.53,,,,,,,,,,,,,,,,,,,Other,2402.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2402.25,2402.25, VIABAHN ENDOPROSTHESIS,C1874,HCPCS,278,RC,,,,both,23021.49,16115.04,,,,,,,,,,,,,,,,,,,Other,4963.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4963.44,4963.44, VIABAHN SX ENDO HEPARIN 18 RO 6MMX15CM 6,C1874,HCPCS,278,RC,,,,both,13469.85,9428.9,,,,,,,,,,,,,,,,,,,Other,2904.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2904.1,2904.1, VIABAHN BX BALLOON ENDO 7FR 135CM CATH H,C1874,HCPCS,278,RC,,,,both,11088.9,7762.23,,,,,,,,,,,,,,,,,,,Other,2390.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2390.77,2390.77, VIABAHN BX BALLOON ENDO 7FR 135CM CATH H,C1874,HCPCS,278,RC,,,,both,11088.9,7762.23,,,,,,,,,,,,,,,,,,,Other,2390.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2390.77,2390.77, VIABAHN BX BALLOON EXP ENDO 7X79MM 7FR,C1874,HCPCS,278,RC,,,,both,11866.21,8306.35,,,,,,,,,,,,,,,,,,,Other,2558.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2558.36,2558.36, OPEP DEVICE POCKETPEP,270,RC,,,,,,both,171.82,120.27,,,,,,,,,,,,,,,,,,,Other,37.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.04,37.04, SHEATH 6FR BRITE TIP 23CM,272,RC,,,,,,both,147.16,103.01,,,,,,,,,,,,,,,,,,,Other,31.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,31.73,31.73, SHEATH 7FR BRITE TIP,272,RC,,,,,,both,150.45,105.32,,,,,,,,,,,,,,,,,,,Other,32.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.44,32.44, SHEATH 7FR BRITE TIP 23CM .97MM,272,RC,,,,,,both,167.79,117.45,,,,,,,,,,,,,,,,,,,Other,36.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.17,36.17, SHEATH 7FR X 11CM BRITE TIP,272,RC,,,,,,both,51.25,35.88,,,,,,,,,,,,,,,,,,,Other,11.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.05,11.05, SHEATH 8FR X 35CM BRITE TIP,272,RC,,,,,,both,149.36,104.55,,,,,,,,,,,,,,,,,,,Other,32.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.2,32.2, SHEATH 9FR X 23CM BRITE TIP,272,RC,,,,,,both,151.18,105.83,,,,,,,,,,,,,,,,,,,Other,32.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.59,32.59, SHEATH 10FR X 11CM BRITE TIP,272,RC,,,,,,both,51.25,35.88,,,,,,,,,,,,,,,,,,,Other,11.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.05,11.05, SHEATH 9FR X 35CM BRITE TIP,272,RC,,,,,,both,245.57,171.9,,,,,,,,,,,,,,,,,,,Other,52.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,52.95,52.95, SHEATH SUPER 9FR,272,RC,,,,,,both,77.9,54.53,,,,,,,,,,,,,,,,,,,Other,16.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.8,16.8, SHEATH SUPER 10FR,272,RC,,,,,,both,37.52,26.26,,,,,,,,,,,,,,,,,,,Other,8.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.08,8.08, STENT PALMAZ 7FR X 80 CM CORINTHIAN,C1874,HCPCS,278,RC,,,,both,3916.02,2741.21,,,,,,,,,,,,,,,,,,,Other,844.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,844.29,844.29, CATH TRANSIT MICRO 3MMX135CM,272,RC,,,,,,both,1141.46,799.02,,,,,,,,,,,,,,,,,,,Other,246.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,246.1,246.1, CATH GLIDE 4FR 100CM NON-TAPER ANGLE,272,RC,,,,,,both,319.68,223.78,,,,,,,,,,,,,,,,,,,Other,68.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.92,68.92, CATH GLIDE 4FR 65CM,272,RC,,,,,,both,251.12,175.78,,,,,,,,,,,,,,,,,,,Other,54.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,54.14,54.14, WIRE MAGIC TORQUE,272,RC,,,,,,both,247.22,173.05,,,,,,,,,,,,,,,,,,,Other,53.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,53.3,53.3, GUIDE WIRE AMPLATE,C1769,HCPCS,278,RC,,,,both,201.72,141.2,,,,,,,,,,,,,,,,,,,Other,43.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.49,43.49, STENT SMART 10X20X120,C1874,HCPCS,278,RC,,,,both,4944.98,3461.49,,,,,,,,,,,,,,,,,,,Other,1066.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1066.14,1066.14, STENT SMART 14X40X80,C1874,HCPCS,278,RC,,,,both,4706.72,3294.7,,,,,,,,,,,,,,,,,,,Other,1014.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1014.77,1014.77, CATH DILATION PTA PRO 8MMX4CMX80CM,272,RC,,,,,,both,744.58,521.21,,,,,,,,,,,,,,,,,,,Other,160.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,160.53,160.53, CATH PIGTAIL 4FR 65CM,272,RC,,,,,,both,299.7,209.79,,,,,,,,,,,,,,,,,,,Other,64.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,64.61,64.61, CATH PIGTAIL 4FR 100CM,272,RC,,,,,,both,299.7,209.79,,,,,,,,,,,,,,,,,,,Other,64.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,64.61,64.61, CATH PIGTAIL 5FR 65CM,272,RC,,,,,,both,439.02,307.31,,,,,,,,,,,,,,,,,,,Other,94.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,94.65,94.65, CATHETER CENTESIS ONE STEP 6FR,C1725,HCPCS,272,RC,,,,both,133.2,93.24,,,,,,,,,,,,,,,,,,,Other,28.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28.71,28.71, CATH GUIDE 6FR 90CM PV MACH 1,C1725,HCPCS,278,RC,,,,both,200.9,140.63,,,,,,,,,,,,,,,,,,,Other,43.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.32,43.32, CATH GUIDE RUNWAY MP2,C1725,HCPCS,278,RC,,,,both,532.79,372.95,,,,,,,,,,,,,,,,,,,Other,114.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,114.87,114.87, CATH GUIDE RUNWAY JR4,C1725,HCPCS,278,RC,,,,both,532.79,372.95,,,,,,,,,,,,,,,,,,,Other,114.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,114.87,114.87, CATH VIPER SMALL VESSEL BA,272,RC,,,,,,both,1418.92,993.24,,,,,,,,,,,,,,,,,,,Other,305.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,305.92,305.92, KIT BIO PREP,272,RC,,,,,,both,1053.64,737.55,,,,,,,,,,,,,,,,,,,Other,227.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,227.16,227.16, BONE CEMENT MIXING AND DELIVERY SYSTEM C,272,RC,,,,,,both,423.21,296.25,,,,,,,,,,,,,,,,,,,Other,91.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,91.25,91.25, CLEARMIX SINGLE DOUBLE MIX,272,RC,,,,,,both,353.15,247.21,,,,,,,,,,,,,,,,,,,Other,76.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,76.14,76.14, STENT EPIC 10X20 x 75CM SELF EXPANDING,C1874,HCPCS,278,RC,,,,both,3995.94,2797.16,,,,,,,,,,,,,,,,,,,Other,861.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,861.53,861.53, STENT EPIC 12X60X75CM SELF EXPANDING VA,C1874,HCPCS,278,RC,,,,both,3995.94,2797.16,,,,,,,,,,,,,,,,,,,Other,861.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,861.53,861.53, STENT EPIC 6X30 SELF EXPANDING VASCULAR,C1874,HCPCS,278,RC,,,,both,3995.94,2797.16,,,,,,,,,,,,,,,,,,,Other,861.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,861.53,861.53, STENT EPIC 6X60 SELF EXPANDING VASCULAR,C1874,HCPCS,278,RC,,,,both,3995.94,2797.16,,,,,,,,,,,,,,,,,,,Other,861.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,861.53,861.53, STENT EPIC 8X30 SELF EXPANDING VASCULAR,C1874,HCPCS,278,RC,,,,both,3995.94,2797.16,,,,,,,,,,,,,,,,,,,Other,861.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,861.53,861.53, STENT EPIC 8X40 SELF EXPANDING VASCULAR,C1874,HCPCS,278,RC,,,,both,3995.94,2797.16,,,,,,,,,,,,,,,,,,,Other,861.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,861.53,861.53, STENT EPIC 8X60 SELF EXPANDING VASCULAR,C1874,HCPCS,278,RC,,,,both,3995.94,2797.16,,,,,,,,,,,,,,,,,,,Other,861.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,861.53,861.53, STENT EPIC 10X40 SELF EXPANDING VASCULAR,C1874,HCPCS,278,RC,,,,both,3995.94,2797.16,,,,,,,,,,,,,,,,,,,Other,861.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,861.53,861.53, STENT EPIC 10X60 SELF EXPANDING VASCULAR,C1874,HCPCS,278,RC,,,,both,3995.94,2797.16,,,,,,,,,,,,,,,,,,,Other,861.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,861.53,861.53, STENT EPIC 10X40X120 VASCULAR,C1874,HCPCS,278,RC,,,,both,3995.94,2797.16,,,,,,,,,,,,,,,,,,,Other,861.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,861.53,861.53, STENT EPIC 10X20X120 SELF EXPANDING VASC,C1874,HCPCS,278,RC,,,,both,3995.94,2797.16,,,,,,,,,,,,,,,,,,,Other,861.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,861.53,861.53, GUIDE WIRE V-14 300CM,C1769,HCPCS,278,RC,,,,both,716.96,501.87,,,,,,,,,,,,,,,,,,,Other,154.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,154.58,154.58, GUIDE WIRE V-18 300CM,C1769,HCPCS,272,RC,,,,both,293.04,205.13,,,,,,,,,,,,,,,,,,,Other,63.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,63.18,63.18, GUIDE WIRE TSFNB-38-1,C1769,HCPCS,278,RC,,,,both,38.74,27.12,,,,,,,,,,,,,,,,,,,Other,8.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.35,8.35, COIL TORNADO 3MM 2MM,272,RC,,,,,,both,374.75,262.33,,,,,,,,,,,,,,,,,,,Other,80.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,80.8,80.8, COIL TORNADO 4MM 2MM,272,RC,,,,,,both,374.75,262.33,,,,,,,,,,,,,,,,,,,Other,80.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,80.8,80.8, COIL TORNADO 5MM 2MM,272,RC,,,,,,both,374.75,262.33,,,,,,,,,,,,,,,,,,,Other,80.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,80.8,80.8, COIL TORNADO 6MM 2MM,272,RC,,,,,,both,374.75,262.33,,,,,,,,,,,,,,,,,,,Other,80.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,80.8,80.8, STENT SMART 8X20,C1874,HCPCS,278,RC,,,,both,4944.98,3461.49,,,,,,,,,,,,,,,,,,,Other,1066.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1066.14,1066.14, STENT WALL 10FR 20X60 230 CM,C1874,HCPCS,278,RC,,,,both,5439.48,3807.64,,,,,,,,,,,,,,,,,,,Other,1172.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1172.76,1172.76, STENT WALL 10FR 22X60 230 CM,C1874,HCPCS,278,RC,,,,both,5439.48,3807.64,,,,,,,,,,,,,,,,,,,Other,1172.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1172.76,1172.76, STENT WALL 10FR 20X60 230 CM,C1874,HCPCS,278,RC,,,,both,5439.48,3807.64,,,,,,,,,,,,,,,,,,,Other,1172.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1172.76,1172.76, STENT WALL 10FR 22X60 135 CM,C1874,HCPCS,278,RC,,,,both,5439.48,3807.64,,,,,,,,,,,,,,,,,,,Other,1172.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1172.76,1172.76, PASSER (PUNCTURE CLOSURE DEVICE,272,RC,,,,,,both,129.77,90.84,,,,,,,,,,,,,,,,,,,Other,27.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,27.98,27.98, STENT BEV WL 7.5 10X42X75,C1874,HCPCS,278,RC,,,,both,3579.7,2505.79,,,,,,,,,,,,,,,,,,,Other,771.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,771.78,771.78, GUIDE WIRE ANPLATZ STIFF,C1769,HCPCS,278,RC,,,,both,195.84,137.09,,,,,,,,,,,,,,,,,,,Other,42.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.22,42.22, STENT WALL B10687110,C1874,HCPCS,278,RC,,,,both,3579.7,2505.79,,,,,,,,,,,,,,,,,,,Other,771.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,771.78,771.78, STENT WALL B8607110,C1874,HCPCS,278,RC,,,,both,3579.7,2505.79,,,,,,,,,,,,,,,,,,,Other,771.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,771.78,771.78, CATH POWER FLEX 80 CM,272,RC,,,,,,both,743.71,520.6,,,,,,,,,,,,,,,,,,,Other,160.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,160.35,160.35, CATH ENDOBRONCHO 35FR LEFT,272,RC,,,,,,both,166.9,116.83,,,,,,,,,,,,,,,,,,,Other,35.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.99,35.99, CATH COOK 159683,272,RC,,,,,,both,164.28,115,,,,,,,,,,,,,,,,,,,Other,35.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.42,35.42, CATH 5FR-100CM-.035-STRAIGHT,272,RC,,,,,,both,60.55,42.39,,,,,,,,,,,,,,,,,,,Other,13.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.05,13.05, SHEATH FLO CHECK 4FR X 12CM,272,RC,,,,,,both,42.8,29.96,,,,,,,,,,,,,,,,,,,Other,9.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.23,9.23, CATH STRAIGHT P5.0B-38-65-M-NS-0 CUST4-6,272,RC,,,,,,both,115.63,80.94,,,,,,,,,,,,,,,,,,,Other,24.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.93,24.93, CATH STRAIGHT .035 4FR 100 CM,272,RC,,,,,,both,131.8,92.26,,,,,,,,,,,,,,,,,,,Other,28.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28.42,28.42, CATH TORCON ADV/5FR,272,RC,,,,,,both,78.91,55.24,,,,,,,,,,,,,,,,,,,Other,17.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.01,17.01, WIRE KIRCHNER .045,272,RC,,,,,,both,29.18,20.43,,,,,,,,,,,,,,,,,,,Other,6.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.29,6.29, "WIRE KIRCHNER .9MM LENGTH 9"" STYLE 7",272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, CATH TRIGUIDE 7FR,272,RC,,,,,,both,347.71,243.4,,,,,,,,,,,,,,,,,,,Other,74.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,74.97,74.97, NEEDLE INTRA CDIN 14G 3CM,272,RC,,,,,,both,227.57,159.3,,,,,,,,,,,,,,,,,,,Other,49.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,49.07,49.07, NEEDLE C-DIN 16G 3CM,272,RC,,,,,,both,188.25,131.78,,,,,,,,,,,,,,,,,,,Other,40.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.59,40.59, CATH PIGTAIL 4FR X 125CM INFINITY,272,RC,,,,,,both,145.95,102.17,,,,,,,,,,,,,,,,,,,Other,31.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,31.47,31.47, CATH STRAIGHT 5.0,272,RC,,,,,,both,93.44,65.41,,,,,,,,,,,,,,,,,,,Other,20.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.15,20.15, CATH STRAIGHT 4FR,A4353,HCPCS,272,RC,,,,both,75.67,52.97,,,,,,,,,,,,,,,,,,,Other,16.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.32,16.32, WIRE INFUSION KATZEN,272,RC,,,,,,both,670.83,469.58,,,,,,,,,,,,,,,,,,,Other,144.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,144.63,144.63, CATH STRAIGHT 4FR 125CM,272,RC,,,,,,both,75.67,52.97,,,,,,,,,,,,,,,,,,,Other,16.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.32,16.32, BALLON DILATATION CATH XXL 7F 12MM X 2C,C1725,HCPCS,278,RC,,,,both,954.19,667.93,,,,,,,,,,,,,,,,,,,Other,205.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,205.72,205.72, GUIDE WIRE 180CM PLATINUM,C1769,HCPCS,278,RC,,,,both,411.29,287.9,,,,,,,,,,,,,,,,,,,Other,88.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,88.67,88.67, STENT 24MMX3.5MM,C1874,HCPCS,278,RC,,,,both,6626.6,4638.62,,,,,,,,,,,,,,,,,,,Other,1428.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1428.69,1428.69, STENT PROMUS PREMIER 4.00MM X 12MM,C1874,HCPCS,278,RC,,,,both,6992.89,4895.02,,,,,,,,,,,,,,,,,,,Other,1507.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1507.67,1507.67, CATH HI-FLOW 4FR 110CM,272,RC,,,,,,both,80,56,,,,,,,,,,,,,,,,,,,Other,17.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.25,17.25, CATH DILATION 2.5MMX10CMX135CM,C1725,HCPCS,278,RC,,,,both,1135.01,794.51,,,,,,,,,,,,,,,,,,,Other,244.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,244.71,244.71, CATH DILATION 3.0MMX10CMX135CM,C1725,HCPCS,278,RC,,,,both,1135.01,794.51,,,,,,,,,,,,,,,,,,,Other,244.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,244.71,244.71, CATH POLAR 2.5MMX100CMX135CM,C1725,HCPCS,278,RC,,,,both,2996.95,2097.87,,,,,,,,,,,,,,,,,,,Other,646.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,646.14,646.14, CATH BALLOON STERLING 5MMX12CMX80CM,272,RC,,,,,,both,834.28,584,,,,,,,,,,,,,,,,,,,Other,179.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,179.87,179.87, GUIDE WIRE PLATINUM PLUS .018X260CM,C1769,HCPCS,272,RC,,,,both,432.9,303.03,,,,,,,,,,,,,,,,,,,Other,93.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,93.34,93.34, GUIDE WIRE M 46-254,C1769,HCPCS,278,RC,,,,both,246.79,172.75,,,,,,,,,,,,,,,,,,,Other,53.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,53.2,53.2, CATH PIGTAIL COOK 5057,272,RC,,,,,,both,65.73,46.01,,,,,,,,,,,,,,,,,,,Other,14.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.17,14.17, GUIDE WIRE CRAGG FX46-214,C1769,HCPCS,278,RC,,,,both,737.25,516.08,,,,,,,,,,,,,,,,,,,Other,158.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,158.96,158.96, SHUTTLE SL 6FR 90CM,272,RC,,,,,,both,528.06,369.64,,,,,,,,,,,,,,,,,,,Other,113.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,113.85,113.85, SHUTTLE SL 7FR 90CM,272,RC,,,,,,both,528.06,369.64,,,,,,,,,,,,,,,,,,,Other,113.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,113.85,113.85, CATH SLIP 5FR 100CM HI,272,RC,,,,,,both,218.88,153.22,,,,,,,,,,,,,,,,,,,Other,47.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.19,47.19, CATH SLIP 5FR 100CM JB1,272,RC,,,,,,both,218.88,153.22,,,,,,,,,,,,,,,,,,,Other,47.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.19,47.19, CATH SLIP 5FR 100CM JB2,272,RC,,,,,,both,218.88,153.22,,,,,,,,,,,,,,,,,,,Other,47.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.19,47.19, STENT ICAST 8X59X80,C1874,HCPCS,278,RC,,,,both,9407.11,6584.98,,,,,,,,,,,,,,,,,,,Other,2028.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2028.17,2028.17, DNU STENT URETHERAL SOFT 6X26,C1874,HCPCS,278,RC,,,,both,679.31,475.52,,,,,,,,,,,,,,,,,,,Other,146.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,146.46,146.46, DNU STENT URETHERAL SOFT 6X24,C1874,HCPCS,278,RC,,,,both,695.96,487.17,,,,,,,,,,,,,,,,,,,Other,150.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,150.05,150.05, STENT URETHERAL SOFT 4.87FRX22CM,C1874,HCPCS,278,RC,,,,both,679.31,475.52,,,,,,,,,,,,,,,,,,,Other,146.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,146.46,146.46, STENT COLONIC 4CM 31FR,C1874,HCPCS,278,RC,,,,both,3740.4,2618.28,,,,,,,,,,,,,,,,,,,Other,806.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,806.43,806.43, STENT COLONIC 6CM 31FR,C1874,HCPCS,278,RC,,,,both,3901.9,2731.33,,,,,,,,,,,,,,,,,,,Other,841.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,841.25,841.25, STENT COLONIC 10CM 31FR,C1874,HCPCS,278,RC,,,,both,4696.49,3287.54,,,,,,,,,,,,,,,,,,,Other,1012.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1012.57,1012.57, STENT URETHERAL SOFT 6X22-30,C2617,HCPCS,278,RC,,,,both,371.93,260.35,,,,,,,,,,,,,,,,,,,Other,80.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,80.18,80.18, CATH BALLOON STERLING 6MMX40CMX135QCM,C1725,HCPCS,272,RC,,,,both,632.7,442.89,,,,,,,,,,,,,,,,,,,Other,136.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,136.41,136.41, CATH PTA BALLOON DILATION 4MMX40CMX146CM,C1725,HCPCS,272,RC,,,,both,994.65,696.26,,,,,,,,,,,,,,,,,,,Other,214.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,214.44,214.44, GUIDE MPA 1 598 942,C1769,HCPCS,278,RC,,,,both,399.59,279.71,,,,,,,,,,,,,,,,,,,Other,86.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,86.15,86.15, STENT PERCUFLEX 8FRX30CM,C1874,HCPCS,278,RC,,,,both,261.01,182.71,,,,,,,,,,,,,,,,,,,Other,56.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,56.27,56.27, CATH 4FR 65CM .035 IMAGER II SELECTIVE,272,RC,,,,,,both,60.55,42.39,,,,,,,,,,,,,,,,,,,Other,13.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.05,13.05, STENT EXPRESS RENAL 5X15 90CM,C1874,HCPCS,278,RC,,,,both,2497.5,1748.25,,,,,,,,,,,,,,,,,,,Other,538.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,538.46,538.46, GATEWAY ADVANTAGE Y-ADAPTER,272,RC,,,,,,both,66.21,46.35,,,,,,,,,,,,,,,,,,,Other,14.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.28,14.28, COYOTE ES MONORAIL 3X20X114,C1725,HCPCS,272,RC,,,,both,1176.8,823.76,,,,,,,,,,,,,,,,,,,Other,253.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,253.72,253.72, GUIDE WIRE 9316,C1769,HCPCS,278,RC,,,,both,74.58,52.21,,,,,,,,,,,,,,,,,,,Other,16.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.08,16.08, STERLING 5X40MM X 135CM 4FR SHEATH,C1725,HCPCS,272,RC,,,,both,632.7,442.89,,,,,,,,,,,,,,,,,,,Other,136.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,136.41,136.41, STERLING BALLON 5X20X135,C1725,HCPCS,272,RC,,,,both,632.7,442.89,,,,,,,,,,,,,,,,,,,Other,136.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,136.41,136.41, STERLING OVER THE WIRE BALLOON 6X20X135,C1725,HCPCS,272,RC,,,,both,632.7,442.89,,,,,,,,,,,,,,,,,,,Other,136.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,136.41,136.41, STENT ESOPHAGEAL W/DUA 12CM,278,RC,,,,,,both,9075.47,6352.83,,,,,,,,,,,,,,,,,,,Other,1956.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1956.67,1956.67, SYMMETRY BALLOON DILATION CATH 2.5MMX100,C1725,HCPCS,278,RC,,,,both,1075.59,752.91,,,,,,,,,,,,,,,,,,,Other,231.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,231.9,231.9, STENT 4.8FR 22-30CM CONTOUR URETERAL,C1874,HCPCS,278,RC,,,,both,388.58,272.01,,,,,,,,,,,,,,,,,,,Other,83.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,83.78,83.78, STERLING OVER THE WIRE BALLOON 6X80X80,272,RC,,,,,,both,632.7,442.89,,,,,,,,,,,,,,,,,,,Other,136.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,136.41,136.41, GUIDE WIRE 9911,C1769,HCPCS,278,RC,,,,both,65.64,45.95,,,,,,,,,,,,,,,,,,,Other,14.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.15,14.15, CATH STRAIGHT 4FRX65CMX.035 0 SIDE HOLES,272,RC,,,,,,both,108.11,75.68,,,,,,,,,,,,,,,,,,,Other,23.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.3,23.3, CATH STRAIGHT 4FRX100CMX.035 0 SIDE HOLE,272,RC,,,,,,both,90.81,63.57,,,,,,,,,,,,,,,,,,,Other,19.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.58,19.58, CATH STRAIGHT 4FRX65CM,272,RC,,,,,,both,82.17,57.52,,,,,,,,,,,,,,,,,,,Other,17.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.72,17.72, GUIDE WIRE AMPLATZ EMERALD .035X180CM,C1769,HCPCS,278,RC,,,,both,188.69,132.08,,,,,,,,,,,,,,,,,,,Other,40.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.68,40.68, GUIDE WIRE STRAIGHT CATH EXCHANGE,C1769,HCPCS,278,RC,,,,both,59.45,41.62,,,,,,,,,,,,,,,,,,,Other,12.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.82,12.82, GUIDE WIRE AMPLATZ EMERALD,C1769,HCPCS,278,RC,,,,both,172.2,120.54,,,,,,,,,,,,,,,,,,,Other,37.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.12,37.12, CATH STRAIGHT 4FRX65CM,272,RC,,,,,,both,82.17,57.52,,,,,,,,,,,,,,,,,,,Other,17.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.72,17.72, GUIDE MPA1 586 842,C1769,HCPCS,278,RC,,,,both,366.29,256.4,,,,,,,,,,,,,,,,,,,Other,78.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,78.97,78.97, GUIDE SON 1 586 880,C1769,HCPCS,278,RC,,,,both,366.29,256.4,,,,,,,,,,,,,,,,,,,Other,78.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,78.97,78.97, SHEATH 5FR CHECK-FLO,272,RC,,,,,,both,78.66,55.06,,,,,,,,,,,,,,,,,,,Other,16.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.96,16.96, GUIDE WIRE TM 480 A,C1769,HCPCS,278,RC,,,,both,500.66,350.46,,,,,,,,,,,,,,,,,,,Other,107.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,107.95,107.95, GUIDE WIRE TM 260 A,C1769,HCPCS,278,RC,,,,both,283.05,198.14,,,,,,,,,,,,,,,,,,,Other,61.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.02,61.02, IMPRESS KA2 CATHETER 4F 65CM,272,RC,,,,,,both,166.79,116.75,,,,,,,,,,,,,,,,,,,Other,35.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.96,35.96, 9FR 35CM FLEXOR CHECK FLO INTRODUCER SET,272,RC,,,,,,both,568.98,398.29,,,,,,,,,,,,,,,,,,,Other,122.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,122.68,122.68, MULITPORT ADAPTER,272,RC,,,,,,both,151.36,105.95,,,,,,,,,,,,,,,,,,,Other,32.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.63,32.63, NEEDLE W/SELDINGER SHIELD ONE WALL,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, GUIDE WIRE ROSEN 260,C1769,HCPCS,272,RC,,,,both,111.36,77.95,,,,,,,,,,,,,,,,,,,Other,24.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.01,24.01, "GUIDEWIRE STIFF 0.035"" X 260 STRAIGHT",C1769,HCPCS,272,RC,,,,both,118.86,83.2,,,,,,,,,,,,,,,,,,,Other,25.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.63,25.63, "GUIDE WIRE STIFF D.035""L180 STRAIGHT",272,RC,,,,,,both,110.7,77.49,,,,,,,,,,,,,,,,,,,Other,23.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.86,23.86, GUIDE WIRE PLAT PLUS,C1769,HCPCS,278,RC,,,,both,313.89,219.72,,,,,,,,,,,,,,,,,,,Other,67.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,67.68,67.68, GUIDE WIRE 46-601,C1769,HCPCS,278,RC,,,,both,288.05,201.64,,,,,,,,,,,,,,,,,,,Other,62.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,62.1,62.1, GUIDE WIRE 68029,C1769,HCPCS,278,RC,,,,both,71.75,50.23,,,,,,,,,,,,,,,,,,,Other,15.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.47,15.47, GUIDE WIRE 55601,C1769,HCPCS,278,RC,,,,both,62.52,43.76,,,,,,,,,,,,,,,,,,,Other,13.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.48,13.48, GUIDE WIRE PLATINUM PLUS 300CM .014,C1769,HCPCS,272,RC,,,,both,432.9,303.03,,,,,,,,,,,,,,,,,,,Other,93.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,93.34,93.34, GUIDE WIRE AMPLATZ STIFF 46 51A,C1769,HCPCS,278,RC,,,,both,193.52,135.46,,,,,,,,,,,,,,,,,,,Other,41.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.72,41.72, CATH PIGTAIL 4FR 100 CM,272,RC,,,,,,both,169.72,118.8,,,,,,,,,,,,,,,,,,,Other,36.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.59,36.59, CATH DILATION 6MMX4CMX80CM,272,RC,,,,,,both,614.63,430.24,,,,,,,,,,,,,,,,,,,Other,132.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,132.52,132.52, CATH BALLOON STERLING 3.0MMX60MM 150CM,C1725,HCPCS,272,RC,,,,both,791,553.7,,,,,,,,,,,,,,,,,,,Other,170.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,170.54,170.54, STERLING OVER THE WIRE BALLOON 7X80X80,272,RC,,,,,,both,632.7,442.89,,,,,,,,,,,,,,,,,,,Other,136.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,136.41,136.41, CATH 156894 (CUSTOM),272,RC,,,,,,both,65.73,46.01,,,,,,,,,,,,,,,,,,,Other,14.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.17,14.17, SHEATH 8FR/25CM 15-64,272,RC,,,,,,both,149.19,104.43,,,,,,,,,,,,,,,,,,,Other,32.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.16,32.16, CATH STRAIGHT 4FR .035X80CM,272,RC,,,,,,both,124.32,87.02,,,,,,,,,,,,,,,,,,,Other,26.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.8,26.8, CATH TUNNEL 14.5FR RT 28CM,272,RC,,,,,,both,1211.7,848.19,,,,,,,,,,,,,,,,,,,Other,261.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,261.24,261.24, CATH TUNNEL 14.5FR RT 32CM,272,RC,,,,,,both,1211.7,848.19,,,,,,,,,,,,,,,,,,,Other,261.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,261.24,261.24, CATH STRAIGHT 5.0,A4351,HCPCS,272,RC,,,,both,69.19,48.43,,,,,,,,,,,,,,,,,,,Other,14.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.92,14.92, CATH SPY G 4 FR .038-100CM-JR 3.5,272,RC,,,,,,both,43.24,30.27,,,,,,,,,,,,,,,,,,,Other,9.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.32,9.32, CATH SPY G 4 FR .038-100CM-JL 3.5,272,RC,,,,,,both,43.24,30.27,,,,,,,,,,,,,,,,,,,Other,9.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.32,9.32, "CATH PERMCATH 23CM, 40CM OVERALL",272,RC,,,,,,both,800.07,560.05,,,,,,,,,,,,,,,,,,,Other,172.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,172.5,172.5, SET MICROPUNCTURE 4.0,272,RC,,,,,,both,89.87,62.91,,,,,,,,,,,,,,,,,,,Other,19.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.37,19.37, CATH PERMCATH 40CM,272,RC,,,,,,both,598.09,418.66,,,,,,,,,,,,,,,,,,,Other,128.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,128.95,128.95, DNO CATH SPY G 4 FR .038-100CM-JL 5,272,RC,,,,,,both,34.24,23.97,,,,,,,,,,,,,,,,,,,Other,7.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.38,7.38, CATH ULTRA THIN DIAM 4X80CM,272,RC,,,,,,both,744.58,521.21,,,,,,,,,,,,,,,,,,,Other,160.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,160.53,160.53, CATH 5FR SIM-1 SIDEWINDER,272,RC,,,,,,both,64.64,45.25,,,,,,,,,,,,,,,,,,,Other,13.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.94,13.94, CATH SIMMONS II,272,RC,,,,,,both,65.73,46.01,,,,,,,,,,,,,,,,,,,Other,14.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.17,14.17, CATH DRAINAGE FLEXIMA APD/10/20,272,RC,,,,,,both,283.05,198.14,,,,,,,,,,,,,,,,,,,Other,61.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.02,61.02, CATH DRAINAGE FLEXIMA APD/12/25,272,RC,,,,,,both,203.8,142.66,,,,,,,,,,,,,,,,,,,Other,43.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.94,43.94, CATH DRAINAGE 18 FR LOOP TYPE W/O STYLET,C1729,HCPCS,272,RC,,,,both,385.95,270.17,,,,,,,,,,,,,,,,,,,Other,83.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,83.21,83.21, CATH DRAINAGE FLEXIMA 14FR,272,RC,,,,,,both,329.97,230.98,,,,,,,,,,,,,,,,,,,Other,71.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.14,71.14, CATH POWERPICC,272,RC,,,,,,both,345.31,241.72,,,,,,,,,,,,,,,,,,,Other,74.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,74.45,74.45, CATH SUPRAPUBIC INTRODUCER,272,RC,,,,,,both,82.17,57.52,,,,,,,,,,,,,,,,,,,Other,17.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.72,17.72, MICROPUNCTURE WIRE,272,RC,,,,,,both,74.5,52.15,,,,,,,,,,,,,,,,,,,Other,16.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.06,16.06, CATH BALLOON DIAMOND ULTRA 7X4X75,C1725,HCPCS,278,RC,,,,both,582.74,407.92,,,,,,,,,,,,,,,,,,,Other,125.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,125.64,125.64, CATH PIGTAIL 5FR 100CM,272,RC,,,,,,both,60.55,42.39,,,,,,,,,,,,,,,,,,,Other,13.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.05,13.05, CATH C2 4FR,272,RC,,,,,,both,73.51,51.46,,,,,,,,,,,,,,,,,,,Other,15.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.85,15.85, CATH COBRA II 65CM 4FR,272,RC,,,,,,both,80,56,,,,,,,,,,,,,,,,,,,Other,17.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.25,17.25, CATH COBRA 2 AT 100 4FR,272,RC,,,,,,both,55.97,39.18,,,,,,,,,,,,,,,,,,,Other,12.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.06,12.06, CATH BALLOON 5FRX110CM FLOW ASSISTED,C1725,HCPCS,278,RC,,,,both,717.58,502.31,,,,,,,,,,,,,,,,,,,Other,154.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,154.71,154.71, CATH SOFT-VU 4FR 80CM,272,RC,,,,,,both,95.23,66.66,,,,,,,,,,,,,,,,,,,Other,20.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.53,20.53, DNO CATH 5FR SOFT-VU,272,RC,,,,,,both,148.76,104.13,,,,,,,,,,,,,,,,,,,Other,32.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.08,32.08, CATH FLEXIMA OPEN ENDED URO 5FR 70CM,272,RC,,,,,,both,40.75,28.53,,,,,,,,,,,,,,,,,,,Other,8.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.79,8.79, DNO CATH RUTNER 8F CONE TIPPED,272,RC,,,,,,both,70.11,49.08,,,,,,,,,,,,,,,,,,,Other,15.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.11,15.11, DNO CATH OPEN ENDED URETE,272,RC,,,,,,both,61.66,43.16,,,,,,,,,,,,,,,,,,,Other,13.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.3,13.3, CATH BALLOON 5MMX4CMX8CM,C1725,HCPCS,272,RC,,,,both,1126.19,788.33,,,,,,,,,,,,,,,,,,,Other,242.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,242.8,242.8, CATH THRUWAY 190CMX0.14,272,RC,,,,,,both,452.31,316.62,,,,,,,,,,,,,,,,,,,Other,97.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,97.52,97.52, CATH ULTRA THIN DIAMOND 7MMX2CMX75CM,272,RC,,,,,,both,614.63,430.24,,,,,,,,,,,,,,,,,,,Other,132.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,132.52,132.52, CATH BALLOON MUSTANG 7X40X75CM,C1725,HCPCS,272,RC,,,,both,532.8,372.96,,,,,,,,,,,,,,,,,,,Other,114.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,114.88,114.88, ADAPTER INTUBATED FOR CAPONE CO2 SENSOR,272,RC,,,,,,both,41.61,29.13,,,,,,,,,,,,,,,,,,,Other,8.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.97,8.97, ADAPTER NON INTUBATED W/O2 SEATING CAPON,272,RC,,,,,,both,39.05,27.34,,,,,,,,,,,,,,,,,,,Other,8.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.42,8.42, CATH THRUWAY 300CMX0.14,272,RC,,,,,,both,470.39,329.27,,,,,,,,,,,,,,,,,,,Other,101.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,101.42,101.42, DNO SET MICROPUNCTURE MPIS,272,RC,,,,,,both,106.4,74.48,,,,,,,,,,,,,,,,,,,Other,22.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.94,22.94, FANELLI BILIARY STENT SET,C2625,HCPCS,278,RC,,,,both,2097.87,1468.51,,,,,,,,,,,,,,,,,,,Other,452.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,452.3,452.3, DILATOR NOTTINGHAM,272,RC,,,,,,both,435.2,304.64,,,,,,,,,,,,,,,,,,,Other,93.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,93.83,93.83, DILATOR VESSEL,272,RC,,,,,,both,27.11,18.98,,,,,,,,,,,,,,,,,,,Other,5.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.84,5.84, DIALATOR VESSEL 26146,272,RC,,,,,,both,22.62,15.83,,,,,,,,,,,,,,,,,,,Other,4.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.88,4.88, DILATOR 48-153,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, SET DIALATOR 50-314,272,RC,,,,,,both,333.66,233.56,,,,,,,,,,,,,,,,,,,Other,71.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.94,71.94, CATH ACHALASIA BALLOON DILATOR 30MM,C1726,HCPCS,272,RC,,,,both,2047.92,1433.54,,,,,,,,,,,,,,,,,,,Other,441.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,441.53,441.53, CATH ACHALASIA BALLOON DILATOR 35MM,C1726,HCPCS,272,RC,,,,both,2099.12,1469.38,,,,,,,,,,,,,,,,,,,Other,452.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,452.57,452.57, WIRE INFUSION 46-192,272,RC,,,,,,both,705.95,494.17,,,,,,,,,,,,,,,,,,,Other,152.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,152.2,152.2, CATH ACHALASIA BALLOON DILATOR 40MM,272,RC,,,,,,both,2159.99,1511.99,,,,,,,,,,,,,,,,,,,Other,465.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,465.7,465.7, WIRE INFUSION KATZEN,272,RC,,,,,,both,705.95,494.17,,,,,,,,,,,,,,,,,,,Other,152.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,152.2,152.2, BALLOON ESOPHAGEAL FIXED WIRE 5865,C1726,HCPCS,272,RC,,,,both,780.22,546.15,,,,,,,,,,,,,,,,,,,Other,168.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,168.22,168.22, DILATOR VESSEL COOK,272,RC,,,,,,both,55.62,38.93,,,,,,,,,,,,,,,,,,,Other,12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12,12, DILATOR JCD 8.0-38-20,272,RC,,,,,,both,37.74,26.42,,,,,,,,,,,,,,,,,,,Other,8.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.13,8.13, DILATOR JCD 8.0-38-20,272,RC,,,,,,both,34.81,24.37,,,,,,,,,,,,,,,,,,,Other,7.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.51,7.51, COON 14 FR DILATOR,272,RC,,,,,,both,65.35,45.75,,,,,,,,,,,,,,,,,,,Other,14.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.09,14.09, SHEATH W/UNI-VALVE 10,272,RC,,,,,,both,78.91,55.24,,,,,,,,,,,,,,,,,,,Other,17.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.01,17.01, CATH BALLOON MUSTANG 8X40X75,C1725,HCPCS,272,RC,,,,both,532.8,372.96,,,,,,,,,,,,,,,,,,,Other,114.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,114.88,114.88, SHEATH 9FR X 10CM PINNACLE,272,RC,,,,,,both,151.36,105.95,,,,,,,,,,,,,,,,,,,Other,32.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.63,32.63, "DNO SUTURE SILK 4-0 18"" TIES ETH A183H",272,RC,,,,,,both,21.72,15.2,,,,,,,,,,,,,,,,,,,Other,4.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.68,4.68, CATH BALLOON MUSTANG 8X40X135,C1725,HCPCS,272,RC,,,,both,532.8,372.96,,,,,,,,,,,,,,,,,,,Other,114.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,114.88,114.88, SYRINGE INJECTION MEDRAD,272,RC,,,,,,both,38.42,26.89,,,,,,,,,,,,,,,,,,,Other,8.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.28,8.28, WAND TURBINATE REFLEX-45,272,RC,,,,,,both,614.63,430.24,,,,,,,,,,,,,,,,,,,Other,132.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,132.52,132.52, WAND EVAC-XTRA TONSIL/ADENOID,272,RC,,,,,,both,614.63,430.24,,,,,,,,,,,,,,,,,,,Other,132.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,132.52,132.52, SHEATH 9FR X 11CM INTERVENTIONAL,272,RC,,,,,,both,151.36,105.95,,,,,,,,,,,,,,,,,,,Other,32.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.63,32.63, GUIDEWIRE AMPLATZ 0.035 X 75CM,272,RC,,,,,,both,110.7,77.49,,,,,,,,,,,,,,,,,,,Other,23.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.86,23.86, SYRINGE INJECTION 200,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, 5 FR DILATOR (CUSTOM),272,RC,,,,,,both,34.81,24.37,,,,,,,,,,,,,,,,,,,Other,7.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.51,7.51, COON 7 FR DILATOR (CUSTOM),272,RC,,,,,,both,75.85,53.1,,,,,,,,,,,,,,,,,,,Other,16.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.36,16.36, COON 6 FR DILATOR 20CM .038,272,RC,,,,,,both,65.35,45.75,,,,,,,,,,,,,,,,,,,Other,14.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.09,14.09, CATH BALLOON MUSTANG 8X30X75,C1725,HCPCS,272,RC,,,,both,599.39,419.57,,,,,,,,,,,,,,,,,,,Other,129.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,129.23,129.23, COON 10 FR DILATOR,272,RC,,,,,,both,65.35,45.75,,,,,,,,,,,,,,,,,,,Other,14.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.09,14.09, CATH BALLOON CODA 9FR 120CM,C1725,HCPCS,278,RC,,,,both,1475.17,1032.62,,,,,,,,,,,,,,,,,,,Other,318.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,318.05,318.05, COON 12 FR DILATOR,272,RC,,,,,,both,65.34,45.74,,,,,,,,,,,,,,,,,,,Other,14.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.08,14.08, CATH SUPER TORQUE 5FR/J,272,RC,,,,,,both,80,56,,,,,,,,,,,,,,,,,,,Other,17.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.25,17.25, RADIFOCUS GUIDEWIRETORQUE DEVICE,272,RC,,,,,,both,37.64,26.35,,,,,,,,,,,,,,,,,,,Other,8.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.11,8.11, STENT INTRO SYSTEM 10-7,C1874,HCPCS,278,RC,,,,both,410.22,287.15,,,,,,,,,,,,,,,,,,,Other,88.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,88.44,88.44, "GUIDE WIRE - STRAIGHT TIP 0.35"" 150CM",C1769,HCPCS,272,RC,,,,both,160.51,112.36,,,,,,,,,,,,,,,,,,,Other,34.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.6,34.6, "GUIDEWIRE ZIPWIRE 0.035"" X 260CM",C1769,HCPCS,278,RC,,,,both,164,114.8,,,,,,,,,,,,,,,,,,,Other,35.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.36,35.36, GLIDE WIRE 46-152,C1769,HCPCS,278,RC,,,,both,174.14,121.9,,,,,,,,,,,,,,,,,,,Other,37.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.54,37.54, STENT INTRO SYSTEM 10-5,C1874,HCPCS,278,RC,,,,both,586.07,410.25,,,,,,,,,,,,,,,,,,,Other,126.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,126.36,126.36, SHEATH INTRODUCER 7 F,272,RC,,,,,,both,84.33,59.03,,,,,,,,,,,,,,,,,,,Other,18.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.18,18.18, CATH MICRO 3FR 150CM L HI-FLOW,272,RC,,,,,,both,1317.07,921.95,,,,,,,,,,,,,,,,,,,Other,283.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,283.96,283.96, SHEATH INTRODUCER 15-712-1,272,RC,,,,,,both,84.33,59.03,,,,,,,,,,,,,,,,,,,Other,18.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.18,18.18, INTRODUCER SHEATH 15-731,272,RC,,,,,,both,149.19,104.43,,,,,,,,,,,,,,,,,,,Other,32.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.16,32.16, SHEATH PINNACLE 15-73,272,RC,,,,,,both,149.19,104.43,,,,,,,,,,,,,,,,,,,Other,32.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.16,32.16, INTRODUCER COUDE TIP 15X70CM,272,RC,,,,,,both,24.55,17.19,,,,,,,,,,,,,,,,,,,Other,5.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.29,5.29, CATH MICRO INFUSION 2.9DX150LX5,C1887,HCPCS,278,RC,,,,both,649.34,454.54,,,,,,,,,,,,,,,,,,,Other,139.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,139.99,139.99, CATH MICRO INFUSION 2.9DX150LX10,C1887,HCPCS,278,RC,,,,both,649.34,454.54,,,,,,,,,,,,,,,,,,,Other,139.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,139.99,139.99, PAINPUMP BLOCK AID REUSABLE,272,RC,,,,,,both,1192.73,834.91,,,,,,,,,,,,,,,,,,,Other,257.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,257.15,257.15, PAINPUMP 2 400ML,272,RC,,,,,,both,736.32,515.42,,,,,,,,,,,,,,,,,,,Other,158.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,158.75,158.75, SHEATH SUPER 15-735B,272,RC,,,,,,both,153.68,107.58,,,,,,,,,,,,,,,,,,,Other,33.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,33.13,33.13, PERITONEAL DIALYSIS CATH UNIVERSAL TENCK,272,RC,,,,,,both,187.79,131.45,,,,,,,,,,,,,,,,,,,Other,40.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.48,40.48, GUIDEWIRE THRUWAY 300CM 49-297,272,RC,,,,,,both,470.39,329.27,,,,,,,,,,,,,,,,,,,Other,101.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,101.42,101.42, CHRONIC CATHETER ACCESSORY 16FR,272,RC,,,,,,both,166.92,116.84,,,,,,,,,,,,,,,,,,,Other,35.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.99,35.99, DNO WIRE GUIDE EXTRA STIFF LUNDERQUIST,272,RC,,,,,,both,358.24,250.77,,,,,,,,,,,,,,,,,,,Other,77.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,77.23,77.23, TWISTER PLUS 22LD ROTATABLE RETRIEVAL DE,272,RC,,,,,,both,245.86,172.1,,,,,,,,,,,,,,,,,,,Other,53.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,53.01,53.01, CATH TNT GUIDEWIRE TR,C1769,HCPCS,278,RC,,,,both,337.91,236.54,,,,,,,,,,,,,,,,,,,Other,72.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,72.85,72.85, TWISTER PLUS 26LD ROTATABLE RETREVAL DEV,272,RC,,,,,,both,245.86,172.1,,,,,,,,,,,,,,,,,,,Other,53.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,53.01,53.01, RETRIEVER SUTURE BLUE LASSO,272,RC,,,,,,both,129.15,90.41,,,,,,,,,,,,,,,,,,,Other,27.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,27.84,27.84, RETRIEVER SUTURE 10.1,272,RC,,,,,,both,947.16,663.01,,,,,,,,,,,,,,,,,,,Other,204.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,204.21,204.21, RETRIEVER ROTH NET FOOD BOLUS PLATINUM,272,RC,,,,,,both,342.99,240.09,,,,,,,,,,,,,,,,,,,Other,73.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,73.95,73.95, CATH STRAIGHT 5 FR .038X70CM,272,RC,,,,,,both,104.87,73.41,,,,,,,,,,,,,,,,,,,Other,22.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.61,22.61, CATH STRAIGHT 5 FR .038X100CM,272,RC,,,,,,both,104.87,73.41,,,,,,,,,,,,,,,,,,,Other,22.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.61,22.61, "KIT BLOOD CONSERVATION 1/4"" WOUND DRAIN",272,RC,,,,,,both,434.63,304.24,,,,,,,,,,,,,,,,,,,Other,93.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,93.71,93.71, CATH BALLOON DIL 10X40 MUSTANG,C1725,HCPCS,272,RC,,,,both,532.8,372.96,,,,,,,,,,,,,,,,,,,Other,114.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,114.88,114.88, HYDROPHILIC WIRE GUIDE HIWIRE,272,RC,,,,,,both,302.05,211.44,,,,,,,,,,,,,,,,,,,Other,65.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,65.12,65.12, CATH BALLOON DILATION STERLING 4x20x135,C1725,HCPCS,278,RC,,,,both,632.7,442.89,,,,,,,,,,,,,,,,,,,Other,136.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,136.41,136.41, CATH BALLOON 5X2X80 STERLING,C1725,HCPCS,278,RC,,,,both,1126.19,788.33,,,,,,,,,,,,,,,,,,,Other,242.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,242.8,242.8, CATH MUSTANG 9X40X135 6FR,C1725,HCPCS,278,RC,,,,both,532.8,372.96,,,,,,,,,,,,,,,,,,,Other,114.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,114.88,114.88, CATH BALLOON 4X40X145 COYOTE,C1725,HCPCS,278,RC,,,,both,1126.19,788.33,,,,,,,,,,,,,,,,,,,Other,242.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,242.8,242.8, GUIDE WIRE ROADRUNNER .035 260CM,C1769,HCPCS,278,RC,,,,both,339.65,237.76,,,,,,,,,,,,,,,,,,,Other,73.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,73.23,73.23, CATH BALLOON 3X40X145 COYOTE,C1725,HCPCS,278,RC,,,,both,1126.19,788.33,,,,,,,,,,,,,,,,,,,Other,242.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,242.8,242.8, GUIDE WIRE 197303,C1769,HCPCS,278,RC,,,,both,30.75,21.53,,,,,,,,,,,,,,,,,,,Other,6.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.63,6.63, 4FR WOVEN FILIFORM SPIRAL TIP,272,RC,,,,,,both,251.68,176.18,,,,,,,,,,,,,,,,,,,Other,54.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,54.26,54.26, PERI-STRIPS DRY,272,RC,,,,,,both,708.4,495.88,,,,,,,,,,,,,,,,,,,Other,152.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,152.73,152.73, 5F WOVEN FILIFORMS SPIRAL TIP,272,RC,,,,,,both,251.68,176.18,,,,,,,,,,,,,,,,,,,Other,54.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,54.26,54.26, 6F WOVEN FILIFORMS SPIRAL TIP,272,RC,,,,,,both,251.68,176.18,,,,,,,,,,,,,,,,,,,Other,54.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,54.26,54.26, 8FR WOVEN PHILLIPS FOLLOWER,272,RC,,,,,,both,377.69,264.38,,,,,,,,,,,,,,,,,,,Other,81.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.43,81.43, 10FR WOVEN PHILLIPS FOLLOWER,272,RC,,,,,,both,377.69,264.38,,,,,,,,,,,,,,,,,,,Other,81.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.43,81.43, 12FR WOVEN PHILLIPS FOLLOWER,272,RC,,,,,,both,377.69,264.38,,,,,,,,,,,,,,,,,,,Other,81.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.43,81.43, 14FR WOVEN PHILLIPS FOLLOWER,272,RC,,,,,,both,377.69,264.38,,,,,,,,,,,,,,,,,,,Other,81.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.43,81.43, VASC RET FORC 191687,272,RC,,,,,,both,1056.11,739.28,,,,,,,,,,,,,,,,,,,Other,227.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,227.69,227.69, 16FR WOVEN PHILLIPS FOLLOWER,272,RC,,,,,,both,377.69,264.38,,,,,,,,,,,,,,,,,,,Other,81.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.43,81.43, 18FR WOVEN PHILLIPS FOLLOWER,272,RC,,,,,,both,377.69,264.38,,,,,,,,,,,,,,,,,,,Other,81.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.43,81.43, 20FR WOVEN PHILLIPS FOLLOWER,272,RC,,,,,,both,377.69,264.38,,,,,,,,,,,,,,,,,,,Other,81.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.43,81.43, CATH PIGTAIL 7FR,272,RC,,,,,,both,65.73,46.01,,,,,,,,,,,,,,,,,,,Other,14.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.17,14.17, 22FR WOVEN PHILLIPS FOLLOWER,272,RC,,,,,,both,377.69,264.38,,,,,,,,,,,,,,,,,,,Other,81.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.43,81.43, COIL EMBOLIZATION,272,RC,,,,,,both,188.75,132.13,,,,,,,,,,,,,,,,,,,Other,40.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.7,40.7, COIL EMBOLIZATION,272,RC,,,,,,both,188.75,132.13,,,,,,,,,,,,,,,,,,,Other,40.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.7,40.7, COIL EMBOLIZATION MWC,272,RC,,,,,,both,188.75,132.13,,,,,,,,,,,,,,,,,,,Other,40.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.7,40.7, COIL EMBOLIZATION,272,RC,,,,,,both,194.59,136.21,,,,,,,,,,,,,,,,,,,Other,41.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.95,41.95, COIL EMBOLIZATION 959,272,RC,,,,,,both,194.59,136.21,,,,,,,,,,,,,,,,,,,Other,41.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.95,41.95, COIL EMBOLIZATION 390,272,RC,,,,,,both,188.75,132.13,,,,,,,,,,,,,,,,,,,Other,40.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.7,40.7, COIL EMBOLIZATION 5 X,272,RC,,,,,,both,188.75,132.13,,,,,,,,,,,,,,,,,,,Other,40.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.7,40.7, COIL EMBOLIZATION 5 X,272,RC,,,,,,both,188.75,132.13,,,,,,,,,,,,,,,,,,,Other,40.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.7,40.7, HUMIDIFIER PRE-FILLED,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, COIL EMBOLIZATION MWC,272,RC,,,,,,both,231.8,162.26,,,,,,,,,,,,,,,,,,,Other,49.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,49.98,49.98, SHEATH 14 FR X 30 CM,272,RC,,,,,,both,175.67,122.97,,,,,,,,,,,,,,,,,,,Other,37.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.88,37.88, SHEATH 10 FR 90 CM DA,272,RC,,,,,,both,316.1,221.27,,,,,,,,,,,,,,,,,,,Other,68.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.15,68.15, SHEATH 12FR X 75CM 40,272,RC,,,,,,both,351.22,245.85,,,,,,,,,,,,,,,,,,,Other,75.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,75.72,75.72, 24FR WOVEN PHILLIPS FOLLOWER,272,RC,,,,,,both,377.69,264.38,,,,,,,,,,,,,,,,,,,Other,81.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.43,81.43, SHEATH 7FR LONG 501-6,272,RC,,,,,,both,185.34,129.74,,,,,,,,,,,,,,,,,,,Other,39.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.95,39.95, SET COPE LOOP NEPRROSTOMY,272,RC,,,,,,both,598.9,419.23,,,,,,,,,,,,,,,,,,,Other,129.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,129.12,129.12, HIGH FLOW MULTI 8FR 5,271,RC,,,,,,both,82.17,57.52,,,,,,,,,,,,,,,,,,,Other,17.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.72,17.72, WIRE SENSOR DUAL FLEX PTFE,272,RC,,,,,,both,268.26,187.78,,,,,,,,,,,,,,,,,,,Other,57.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,57.84,57.84, PACK TUR LINGERMAN,272,RC,,,,,,both,236.93,165.85,,,,,,,,,,,,,,,,,,,Other,51.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,51.08,51.08, CATH BALLOON COYOTE ES 3X40X146,C1725,HCPCS,278,RC,,,,both,1176.82,823.77,,,,,,,,,,,,,,,,,,,Other,253.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,253.72,253.72, COIL EMBOLIZATION 38-,272,RC,,,,,,both,231.8,162.26,,,,,,,,,,,,,,,,,,,Other,49.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,49.98,49.98, COIL EMBOLIZATION MReye 35-2-3,272,RC,,,,,,both,313.19,219.23,,,,,,,,,,,,,,,,,,,Other,67.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,67.52,67.52, COIL EMBOLIZATION MReye 35-3-3,272,RC,,,,,,both,333.66,233.56,,,,,,,,,,,,,,,,,,,Other,71.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.94,71.94, COIL EMBOLIZATION MReye 35-3-4,272,RC,,,,,,both,329.64,230.75,,,,,,,,,,,,,,,,,,,Other,71.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.07,71.07, COIL EMBOLIZATION MReye 35-3-5,272,RC,,,,,,both,329.64,230.75,,,,,,,,,,,,,,,,,,,Other,71.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.07,71.07, STENT WALL 22X35,C1874,HCPCS,278,RC,,,,both,3844.76,2691.33,,,,,,,,,,,,,,,,,,,Other,828.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,828.93,828.93, STENT WALL 20X40,C1874,HCPCS,278,RC,,,,both,3844.76,2691.33,,,,,,,,,,,,,,,,,,,Other,828.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,828.93,828.93, CATH SUCTION IN LINE ENDOTRACH REPLACEM,272,RC,,,,,,both,24.86,17.4,,,,,,,,,,,,,,,,,,,Other,5.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.36,5.36, SHEATH 11FR 10CM,272,RC,,,,,,both,84.33,59.03,,,,,,,,,,,,,,,,,,,Other,18.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.18,18.18, CATH SYMMETRY 4X2 135,272,RC,,,,,,both,1197.13,837.99,,,,,,,,,,,,,,,,,,,Other,258.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,258.1,258.1, DNO SHEATH 5FR ULTIMUM HEMOSTASIS,272,RC,,,,,,both,34.24,23.97,,,,,,,,,,,,,,,,,,,Other,7.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.38,7.38, CATH SYMMETRY 3X4X135,272,RC,,,,,,both,1197.13,837.99,,,,,,,,,,,,,,,,,,,Other,258.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,258.1,258.1, CATH SYMMETRY 3X2X135,272,RC,,,,,,both,1197.13,837.99,,,,,,,,,,,,,,,,,,,Other,258.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,258.1,258.1, CATH SYMMETRY 5X,272,RC,,,,,,both,1134.43,794.1,,,,,,,,,,,,,,,,,,,Other,244.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,244.58,244.58, DISC GUIDE WIRE .035 X 180,C1769,HCPCS,272,RC,,,,both,253.08,177.16,,,,,,,,,,,,,,,,,,,Other,54.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,54.57,54.57, GUIDE WIRE .035 X 260 STRAIGHT TIP,C1769,HCPCS,278,RC,,,,both,189.88,132.92,,,,,,,,,,,,,,,,,,,Other,40.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.93,40.93, CATH POWER FLEX 8 X 3,272,RC,,,,,,both,743.71,520.6,,,,,,,,,,,,,,,,,,,Other,160.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,160.35,160.35, DNO SENSOR OXYGEN ADULT NELLCOR OXIMAX,272,RC,,,,,,both,61,42.7,,,,,,,,,,,,,,,,,,,Other,13.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.15,13.15, SHEATH UTLTIMUM 5 FR X 23 CM,272,RC,,,,,,both,77.83,54.48,,,,,,,,,,,,,,,,,,,Other,16.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.78,16.78, STENT WALL 6X45X75,C1874,HCPCS,278,RC,,,,both,3759.51,2631.66,,,,,,,,,,,,,,,,,,,Other,810.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,810.55,810.55, CATH SYMMETRY 2X4X135,272,RC,,,,,,both,1197.13,837.99,,,,,,,,,,,,,,,,,,,Other,258.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,258.1,258.1, GUIDEWIRE 0.035 x 180CM ROADRUNNER,C1769,HCPCS,272,RC,,,,both,172.16,120.51,,,,,,,,,,,,,,,,,,,Other,37.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.12,37.12, CATH SPY G 4 FR .038-100CM-3DRC,272,RC,,,,,,both,38.46,26.92,,,,,,,,,,,,,,,,,,,Other,8.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.29,8.29, CATH SPY GLASS 4 FR .038-100CM-JL4,272,RC,,,,,,both,38.46,26.92,,,,,,,,,,,,,,,,,,,Other,8.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.29,8.29, STENT PALMZ BAL EXP,C1874,HCPCS,278,RC,,,,both,2730.56,1911.39,,,,,,,,,,,,,,,,,,,Other,588.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,588.71,588.71, *CATH PLTFRM 6FR 4MA1,272,RC,,,,,,both,351.22,245.85,,,,,,,,,,,,,,,,,,,Other,75.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,75.72,75.72, STENT PRLOAD P3008M,C1874,HCPCS,278,RC,,,,both,3379.9,2365.93,,,,,,,,,,,,,,,,,,,Other,728.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,728.71,728.71, STENT PALMAZ 8MM2908,C1874,HCPCS,278,RC,,,,both,3379.9,2365.93,,,,,,,,,,,,,,,,,,,Other,728.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,728.71,728.71, STENT PALMZ EXP BALL,C1874,HCPCS,278,RC,,,,both,2730.56,1911.39,,,,,,,,,,,,,,,,,,,Other,588.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,588.71,588.71, PURAPLY AM 2X2 COMMERCIAL 4SQ CM,Q4196,HCPCS,278,RC,,,,both,2634.18,1843.93,,,,,,,,,,,,,,,,,,,Other,567.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.87,567.93, BREAST IMPLANT SIZER CONTOUR PROFILE SAL,272,RC,,,,,,both,175.67,122.97,,,,,,,,,,,,,,,,,,,Other,37.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.88,37.88, CONTOUR PROFILE SALINE MAMMARY SIZERS,278,RC,,,,,,both,194.59,136.21,,,,,,,,,,,,,,,,,,,Other,41.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.95,41.95, CONTOUR PROFILE SALINE MAMMARY IMPLANT,278,RC,,,,,,both,2897.55,2028.29,,,,,,,,,,,,,,,,,,,Other,624.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,624.71,624.71, CONTOUR PROFILE SALINE MAMMARY IMPLANT,278,RC,,,,,,both,2107.31,1475.12,,,,,,,,,,,,,,,,,,,Other,454.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,454.34,454.34, CONTOUR PROFILE SALINE MAMMARY IMPLANT,278,RC,,,,,,both,4214.62,2950.23,,,,,,,,,,,,,,,,,,,Other,908.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,908.68,908.68, SHEATH STRAIGHT 6FR X 45CM,272,RC,,,,,,both,491.01,343.71,,,,,,,,,,,,,,,,,,,Other,105.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,105.86,105.86, SHEATH ANGLED 6FR X 45CM,272,RC,,,,,,both,649.35,454.55,,,,,,,,,,,,,,,,,,,Other,140,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,140,140, SHEATH STRAIGHT 7FR X 45CM,272,RC,,,,,,both,483.98,338.79,,,,,,,,,,,,,,,,,,,Other,104.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,104.35,104.35, SHEATH ANGLED 7FR X 45CM,272,RC,,,,,,both,649.35,454.55,,,,,,,,,,,,,,,,,,,Other,140,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,140,140, NAVIGATOR 13/15x36CM SHEATH ACCESS,272,RC,,,,,,both,424.28,297,,,,,,,,,,,,,,,,,,,Other,91.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,91.47,91.47, NAVIGATOR 11/13X36CM SHEATH ACCESS,272,RC,,,,,,both,424.28,297,,,,,,,,,,,,,,,,,,,Other,91.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,91.47,91.47, SINGLE ACTION PUMP 1-WAY CHECK VALVE,272,RC,,,,,,both,158.24,110.77,,,,,,,,,,,,,,,,,,,Other,34.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.11,34.11, NAVIGATOR 11/13X28CM SHEATH ACCESS,272,RC,,,,,,both,424.28,297,,,,,,,,,,,,,,,,,,,Other,91.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,91.47,91.47, NAVIGATOR 12/14X28CM SHEATH ACCESS,272,RC,,,,,,both,424.28,297,,,,,,,,,,,,,,,,,,,Other,91.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,91.47,91.47, NAVIGATOR 13/15X28CM SHEATH ACCESS,272,RC,,,,,,both,424.28,297,,,,,,,,,,,,,,,,,,,Other,91.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,91.47,91.47, CATH BALLOON MUSTANG 9X40X75,C1725,HCPCS,272,RC,,,,both,599.39,419.57,,,,,,,,,,,,,,,,,,,Other,129.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,129.23,129.23, CATH BALLOON COYOTE 2X20X142,C1725,HCPCS,272,RC,,,,both,1126.19,788.33,,,,,,,,,,,,,,,,,,,Other,242.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,242.8,242.8, CATH BALLOON COYOTE 3X20X143,C1725,HCPCS,272,RC,,,,both,1126.19,788.33,,,,,,,,,,,,,,,,,,,Other,242.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,242.8,242.8, DNO TROCAR 10/12MM ETHICON,272,RC,,,,,,both,261.17,182.82,,,,,,,,,,,,,,,,,,,Other,56.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,56.31,56.31, CIRCUIT ANESTHESIA PED 2 LITER BAG,370,RC,,,,,,both,25.68,17.98,,,,,,,,,,,,,,,,,,,Other,5.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.54,5.54, CIRCUIT ANESTHESIA,370,RC,,,,,,both,26.12,18.28,,,,,,,,,,,,,,,,,,,Other,5.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.64,5.64, CIRCUIT JACKSON-REES MODIFIED PED,270,RC,,,,,,both,76.97,53.88,,,,,,,,,,,,,,,,,,,Other,16.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.59,16.59, DNO STOPCOCK 3-WAY,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO CIRCUIT JACKSON-REES 2 LITER,270,RC,,,,,,both,49.73,34.81,,,,,,,,,,,,,,,,,,,Other,10.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.72,10.72, DNU MANIFOLD HI-FLO STOPCOCK,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, "DNO SET ULTRA EXTENSION 36""",272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, MANIFOLD THREE PORT,272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, STOPCOCK FOUR GANG,272,RC,,,,,,both,21.85,15.3,,,,,,,,,,,,,,,,,,,Other,4.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.71,4.71, CIRCUIT VENT W/MR290 SINGLE LIMB HEATED,A4618,HCPCS,271,RC,,,,both,110.91,77.64,,,,,,,,,,,,,,,,,,,Other,23.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.91,23.91, OPTIFLOW NASAL CANNULA SMALL,A4615,HCPCS,270,RC,,,,both,100.68,70.48,,,,,,,,,,,,,,,,,,,Other,21.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,21.71,21.71, OPTIFLOW NASAL CANNULA MEDIUM,A4615,HCPCS,270,RC,,,,both,96.14,67.3,,,,,,,,,,,,,,,,,,,Other,20.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.73,20.73, GRASPER REPOSABLE 38CM,272,RC,,,,,,both,219.78,153.85,,,,,,,,,,,,,,,,,,,Other,47.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.38,47.38, OPTIFLOW PLUS CANNULA LARGE,A4615,HCPCS,270,RC,,,,both,95.82,67.07,,,,,,,,,,,,,,,,,,,Other,20.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.66,20.66, DISPOSABLE 5MM BABCOCK,272,RC,,,,,,both,261.53,183.07,,,,,,,,,,,,,,,,,,,Other,56.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,56.39,56.39, GRASPER 10MM BABCOCK,272,RC,,,,,,both,269.43,188.6,,,,,,,,,,,,,,,,,,,Other,58.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,58.08,58.08, SUB GRASPER 10MM BABCOCK,272,RC,,,,,,both,705.06,493.54,,,,,,,,,,,,,,,,,,,Other,152.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,152.01,152.01, CATH SPYGLASS JR 3.5,272,RC,,,,,,both,47.57,33.3,,,,,,,,,,,,,,,,,,,Other,10.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.26,10.26, NEEDLE ATRAUMATIC SPROTTE SPINAL 22G31/2,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, "NEEDLE ATRAUMATIC SPROTTE SPINAL 22G 6""",272,RC,,,,,,both,51.03,35.72,,,,,,,,,,,,,,,,,,,Other,11.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.01,11.01, NEEDLE ATRAUMATIC SPROTTE SPINAL 25G31/2,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, "DNO NEEDLE HAKKO TUOHY 3 1/2"" 17G",272,RC,,,,,,both,36.7,25.69,,,,,,,,,,,,,,,,,,,Other,7.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.91,7.91, "DNU NEEDLE HAKKO TUOHY 6"" 25G",272,RC,,,,,,both,31.34,21.94,,,,,,,,,,,,,,,,,,,Other,6.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.75,6.75, DNO NEEDLE HAKKO SPINAL 20G 3 1/2',272,RC,,,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, DNO NEEDLE REG SPROTTE 25G 3 1/2,272,RC,,,,,,both,43.02,30.11,,,,,,,,,,,,,,,,,,,Other,9.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.27,9.27, SET TIP DEFLECT EBDOBRONCHIA BLOCKER,272,RC,,,,,,both,623.76,436.63,,,,,,,,,,,,,,,,,,,Other,134.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,134.49,134.49, SET BLOCKER 5.0,272,RC,,,,,,both,623.76,436.63,,,,,,,,,,,,,,,,,,,Other,134.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,134.49,134.49, SET BLOCKER 7.0,272,RC,,,,,,both,623.76,436.63,,,,,,,,,,,,,,,,,,,Other,134.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,134.49,134.49, SET BLOCKER 9.0 78CM,272,RC,,,,,,both,623.76,436.63,,,,,,,,,,,,,,,,,,,Other,134.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,134.49,134.49, SET BLOCKER ELCIP 9.0,272,RC,,,,,,both,571.51,400.06,,,,,,,,,,,,,,,,,,,Other,123.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,123.22,123.22, "DNO NEEDLE ECHOBLOCK NON-INS 21G X 2""",272,RC,,,,,,both,36.11,25.28,,,,,,,,,,,,,,,,,,,Other,7.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.78,7.78, "DNO NEEDLE TUOHY MLE 17G X 3 1/2""",272,RC,,,,,,both,43.02,30.11,,,,,,,,,,,,,,,,,,,Other,9.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.27,9.27, DNO NEEDLE TUOHY MLE 18G X 3 1/2',272,RC,,,,,,both,43.02,30.11,,,,,,,,,,,,,,,,,,,Other,9.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.27,9.27, STENT MEMOTHERM 8 X 40,C1874,HCPCS,278,RC,,,,both,3369.91,2358.94,,,,,,,,,,,,,,,,,,,Other,726.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,726.55,726.55, STENT ACCULINK 6-80X30 190CM,C1874,HCPCS,278,RC,,,,both,7492.39,5244.67,,,,,,,,,,,,,,,,,,,Other,1615.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1615.36,1615.36, FILTER ACCUNET 190CM,278,RC,,,,,,both,5443.88,3810.72,,,,,,,,,,,,,,,,,,,Other,1173.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1173.7,1173.7, CATH BALLOON 95-15,C1725,HCPCS,278,RC,,,,both,748.57,524,,,,,,,,,,,,,,,,,,,Other,161.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,161.4,161.4, CATH KUMAR CHOLANGIOGRAPHY,272,RC,,,,,,both,145.95,102.17,,,,,,,,,,,,,,,,,,,Other,31.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,31.47,31.47, CATH CHOLANGIOGRAM 5FR,272,RC,,,,,,both,196.47,137.53,,,,,,,,,,,,,,,,,,,Other,42.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.36,42.36, STENT SMART 8X40,C1874,HCPCS,278,RC,,,,both,4978.28,3484.8,,,,,,,,,,,,,,,,,,,Other,1073.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1073.32,1073.32, CATH T-TUBE 16FR,272,RC,,,,,,both,28.63,20.04,,,,,,,,,,,,,,,,,,,Other,6.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.17,6.17, HEMOVAC 400 CC W/15 FR WOUND DRAIN/TROCA,272,RC,,,,,,both,29.16,20.41,,,,,,,,,,,,,,,,,,,Other,6.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.29,6.29, SUB BARD 15 FR PVC WOUND DRAINW/TROCAR,272,RC,,,,,,both,21.85,15.3,,,,,,,,,,,,,,,,,,,Other,4.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.71,4.71, SUB FOR WOUND DRAIN KIT 400CC W/TROCAR,A7048,HCPCS,272,RC,,,,both,39.09,27.36,,,,,,,,,,,,,,,,,,,Other,8.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.43,8.43, CATH POLAR 3X100X135X0.014,C1725,HCPCS,278,RC,,,,both,2996.95,2097.87,,,,,,,,,,,,,,,,,,,Other,646.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,646.14,646.14, CATH POLAR 4X40X135X0.014,C1725,HCPCS,278,RC,,,,both,2663.96,1864.77,,,,,,,,,,,,,,,,,,,Other,574.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,574.35,574.35, CATH POLAR 6X40X135X0.014,C1725,HCPCS,278,RC,,,,both,2663.96,1864.77,,,,,,,,,,,,,,,,,,,Other,574.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,574.35,574.35, CATH POLAR 2.5X40X135X0.014,C1725,HCPCS,278,RC,,,,both,2663.96,1864.77,,,,,,,,,,,,,,,,,,,Other,574.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,574.35,574.35, CATH POLAR,C1725,HCPCS,278,RC,,,,both,2663.96,1864.77,,,,,,,,,,,,,,,,,,,Other,574.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,574.35,574.35, STENT SMART 7X80X40,C1876,HCPCS,278,RC,,,,both,4706.89,3294.82,,,,,,,,,,,,,,,,,,,Other,1014.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1014.81,1014.81, "CATH GUID BRI TIP MP-A-1 100CM 6FR .070""",C1876,HCPCS,278,RC,,,,both,372.95,261.07,,,,,,,,,,,,,,,,,,,Other,80.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,80.41,80.41, STENT SMART 6X2X80,C1876,HCPCS,278,RC,,,,both,4445.48,3111.84,,,,,,,,,,,,,,,,,,,Other,958.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,958.45,958.45, STENT SMART 6X2X135,C1876,HCPCS,278,RC,,,,both,4445.48,3111.84,,,,,,,,,,,,,,,,,,,Other,958.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,958.45,958.45, STENT SMART 7X2X80,C1876,HCPCS,278,RC,,,,both,4445.48,3111.84,,,,,,,,,,,,,,,,,,,Other,958.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,958.45,958.45, STENT SMART 7X2X135,C1876,HCPCS,278,RC,,,,both,4944.98,3461.49,,,,,,,,,,,,,,,,,,,Other,1066.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1066.14,1066.14, STENT SMART 8X2X80,C1876,HCPCS,278,RC,,,,both,4445.48,3111.84,,,,,,,,,,,,,,,,,,,Other,958.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,958.45,958.45, STENT SMART 8X2X135,C1876,HCPCS,278,RC,,,,both,4944.98,3461.49,,,,,,,,,,,,,,,,,,,Other,1066.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1066.14,1066.14, STENT SMART 6X4X80,C1876,HCPCS,278,RC,,,,both,4928.33,3449.83,,,,,,,,,,,,,,,,,,,Other,1062.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1062.55,1062.55, STENT SMART 6X4X135,C1876,HCPCS,278,RC,,,,both,4928.33,3449.83,,,,,,,,,,,,,,,,,,,Other,1062.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1062.55,1062.55, STENT SMART 7X4X80,C1876,HCPCS,278,RC,,,,both,4928.33,3449.83,,,,,,,,,,,,,,,,,,,Other,1062.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1062.55,1062.55, STENT SMART 7X4X135,C1876,HCPCS,278,RC,,,,both,4928.33,3449.83,,,,,,,,,,,,,,,,,,,Other,1062.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1062.55,1062.55, STENT SMART 8X4X80,C1876,HCPCS,278,RC,,,,both,4928.33,3449.83,,,,,,,,,,,,,,,,,,,Other,1062.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1062.55,1062.55, STENT SMART 8X4X135,C1876,HCPCS,278,RC,,,,both,5477.77,3834.44,,,,,,,,,,,,,,,,,,,Other,1181.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1181.01,1181.01, STENT SMART 6X6X80,C1876,HCPCS,278,RC,,,,both,4928.33,3449.83,,,,,,,,,,,,,,,,,,,Other,1062.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1062.55,1062.55, STENT SMART 7X6X80,C1876,HCPCS,278,RC,,,,both,4928.33,3449.83,,,,,,,,,,,,,,,,,,,Other,1062.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1062.55,1062.55, STENT SMART 7X60MM 6FR,C1876,HCPCS,278,RC,,,,both,5477.77,3834.44,,,,,,,,,,,,,,,,,,,Other,1181.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1181.01,1181.01, STENT SMART 8X6X80,C1876,HCPCS,278,RC,,,,both,4928.33,3449.83,,,,,,,,,,,,,,,,,,,Other,1062.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1062.55,1062.55, STENT SMART 8X6X135,C1876,HCPCS,278,RC,,,,both,4928.33,3449.83,,,,,,,,,,,,,,,,,,,Other,1062.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1062.55,1062.55, SIZIER SALINE,272,RC,,,,,,both,194.59,136.21,,,,,,,,,,,,,,,,,,,Other,41.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.95,41.95, SUTURE PROLENE 0 CT-1 ETH C821G,272,RC,,,,,,both,78.28,54.8,,,,,,,,,,,,,,,,,,,Other,16.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.88,16.88, MASK LMA UNIQUE SZ 3,271,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, MASK LMA UNIQUE SZ 4,271,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, MASK LMA UNIQUE SZ 5,271,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SYRINGE INFLATION ENCORE 26,272,RC,,,,,,both,114.8,80.36,,,,,,,,,,,,,,,,,,,Other,24.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.75,24.75, STENT POLYFLEX 21X90,C1874,HCPCS,278,RC,,,,both,6992.89,4895.02,,,,,,,,,,,,,,,,,,,Other,1507.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1507.67,1507.67, WIRE HYDRA JAG .035X260CM STRAIGHT TIP,272,RC,,,,,,both,735.81,515.07,,,,,,,,,,,,,,,,,,,Other,158.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,158.64,158.64, JAGWIRE .038IN X 260CM,C1769,HCPCS,272,RC,,,,both,512.81,358.97,,,,,,,,,,,,,,,,,,,Other,110.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,110.56,110.56, JAGWIRE .035IN X 450CM,C1769,HCPCS,272,RC,,,,both,728.33,509.83,,,,,,,,,,,,,,,,,,,Other,157.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,157.03,157.03, JAGWIRE .035IN X 450CM,C1769,HCPCS,272,RC,,,,both,1196.57,837.6,,,,,,,,,,,,,,,,,,,Other,257.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,257.98,257.98, DRAIN SET-END NSL BILY,272,RC,,,,,,both,593.56,415.49,,,,,,,,,,,,,,,,,,,Other,127.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,127.97,127.97, CATH GLO-TIP ANGLED ERCP,272,RC,,,,,,both,280.98,196.69,,,,,,,,,,,,,,,,,,,Other,60.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,60.58,60.58, CLOSURE FAST PREM PCK MIS 7F07,272,RC,,,,,,both,4109.25,2876.48,,,,,,,,,,,,,,,,,,,Other,885.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,885.96,885.96, INFILTRATION TUBING SET,272,RC,,,,,,both,64.87,45.41,,,,,,,,,,,,,,,,,,,Other,13.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.98,13.98, MICRO INTRODUCER,272,RC,,,,,,both,131.9,92.33,,,,,,,,,,,,,,,,,,,Other,28.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28.44,28.44, DO NOT ORDER BURR FLUTED 3MM MATCHSTICK,272,RC,,,,,,both,927.22,649.05,,,,,,,,,,,,,,,,,,,Other,199.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,199.91,199.91, DO NOT ORDER BURR 3.2MM FLUTED CUTTER,272,RC,,,,,,both,835.9,585.13,,,,,,,,,,,,,,,,,,,Other,180.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,180.22,180.22, DO NOT ORDER SPINE DRILL TIP,272,RC,,,,,,both,672.66,470.86,,,,,,,,,,,,,,,,,,,Other,145.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,145.03,145.03, CLIP FIXING DEVICE DISPOSABLE,272,RC,,,,,,both,227.27,159.09,,,,,,,,,,,,,,,,,,,Other,49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,49,49, QUICKCLIP2 2.6MM L 2300MM WL 2.8MM CHANL,272,RC,,,,,,both,272.72,190.9,,,,,,,,,,,,,,,,,,,Other,58.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,58.8,58.8, CATH 7FR ULTRA THINK DIAMOND,272,RC,,,,,,both,614.63,430.24,,,,,,,,,,,,,,,,,,,Other,132.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,132.52,132.52, STENT TRANSHEPATIC BILIARY 5X15,C2625,HCPCS,278,RC,,,,both,4581.18,3206.83,,,,,,,,,,,,,,,,,,,Other,987.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,987.7,987.7, DISP TOURNIQUET CUFF 18X3,272,RC,,,,,,both,78.97,55.28,,,,,,,,,,,,,,,,,,,Other,17.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.02,17.02, DISP TOURNIQUET 24X4,272,RC,,,,,,both,87.74,61.42,,,,,,,,,,,,,,,,,,,Other,18.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.91,18.91, DISP TOURNIQUET CUFF 34X4,272,RC,,,,,,both,101.07,70.75,,,,,,,,,,,,,,,,,,,Other,21.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,21.8,21.8, STENT TRANSHEPATIC BILIARY 5X12,C2625,HCPCS,278,RC,,,,both,4811.78,3368.25,,,,,,,,,,,,,,,,,,,Other,1037.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1037.42,1037.42, CLARIVEIN IC 65CM,272,RC,,,,,,both,1914.75,1340.33,,,,,,,,,,,,,,,,,,,Other,412.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,412.82,412.82, CAPNOLINE SMART H PLUS ADULT W/02,270,RC,,,,,,both,81.42,56.99,,,,,,,,,,,,,,,,,,,Other,17.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.55,17.55, DNO SORBAFIX FIXATION DEVICE LAP,272,RC,,,,,,both,2787.21,1951.05,,,,,,,,,,,,,,,,,,,Other,600.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,600.93,600.93, CLARIVEIN IC 85CM,272,RC,,,,,,both,2282.95,1598.07,,,,,,,,,,,,,,,,,,,Other,492.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,492.2,492.2, STENT TRANSHEPATIC BILIARY 7X29,C2625,HCPCS,278,RC,,,,both,4478.78,3135.15,,,,,,,,,,,,,,,,,,,Other,965.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,965.62,965.62, MICROSTREAM FILTER LINE INTUBATED,270,RC,,,,,,both,31.29,21.9,,,,,,,,,,,,,,,,,,,Other,6.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.74,6.74, STENT TRANSHEPATIC BILIARY 8X29,C2625,HCPCS,278,RC,,,,both,4254.85,2978.4,,,,,,,,,,,,,,,,,,,Other,917.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,917.35,917.35, SECURESTRAP 5MM ABSORBABLE STRAP FIXATIO,272,RC,,,,,,both,1680.65,1176.46,,,,,,,,,,,,,,,,,,,Other,362.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,362.35,362.35, STENT TRANSHEPATIC BILIARY 7X39,C2625,HCPCS,278,RC,,,,both,4413.01,3089.11,,,,,,,,,,,,,,,,,,,Other,951.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,951.44,951.44, STENT TRANSHEPATIC BILIARY 8X39,C2625,HCPCS,278,RC,,,,both,4413.01,3089.11,,,,,,,,,,,,,,,,,,,Other,951.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,951.44,951.44, CATH GUIDE 55CM 6F,C1887,HCPCS,278,RC,,,,both,193.37,135.36,,,,,,,,,,,,,,,,,,,Other,41.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.69,41.69, CATH BERENSTEIN 4 FR X 125 CM,272,RC,,,,,,both,116.24,81.37,,,,,,,,,,,,,,,,,,,Other,25.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.06,25.06, CATH CROSS OVER TEMPO 5F 65 CM 0 SIDE,272,RC,,,,,,both,95.13,66.59,,,,,,,,,,,,,,,,,,,Other,20.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.51,20.51, DNO CATH BERENSTEIN 4 FR X 150 CM,272,RC,,,,,,both,209.79,146.85,,,,,,,,,,,,,,,,,,,Other,45.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,45.23,45.23, CATH INFUSION 4FR 135X5 CM,272,RC,,,,,,both,612.05,428.44,,,,,,,,,,,,,,,,,,,Other,131.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,131.96,131.96, CATH BERENSTEIN 4 FR X 65 CM,272,RC,,,,,,both,54.85,38.4,,,,,,,,,,,,,,,,,,,Other,11.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.83,11.83, CATH INFUSION 4FR 135X10 CM,272,RC,,,,,,both,1105.56,773.89,,,,,,,,,,,,,,,,,,,Other,238.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,238.36,238.36, STENT TRANSHEPATIC BILIARY 6X12,C2625,HCPCS,278,RC,,,,both,4581.18,3206.83,,,,,,,,,,,,,,,,,,,Other,987.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,987.7,987.7, STENT TRANSHEPATIC BILIARY 6X15,C2625,HCPCS,278,RC,,,,both,4581.18,3206.83,,,,,,,,,,,,,,,,,,,Other,987.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,987.7,987.7, STENT TRANSHEPATIC BILIARY 5X18,C2625,HCPCS,278,RC,,,,both,4811.78,3368.25,,,,,,,,,,,,,,,,,,,Other,1037.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1037.42,1037.42, STENT TRANSHEPATIC BILIARY 6X18,C2625,HCPCS,278,RC,,,,both,4581.18,3206.83,,,,,,,,,,,,,,,,,,,Other,987.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,987.7,987.7, STENT TRANSHEPATIC BILIARY 6X23,C2625,HCPCS,278,RC,,,,both,4634.46,3244.12,,,,,,,,,,,,,,,,,,,Other,999.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,999.19,999.19, STENT BLUE 5MMX18MMX80CM,C2625,HCPCS,278,RC,,,,both,4438.82,3107.17,,,,,,,,,,,,,,,,,,,Other,957.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,957.01,957.01, STENT BLUE 5MMX24MMX80CM,C2625,HCPCS,278,RC,,,,both,4634.62,3244.23,,,,,,,,,,,,,,,,,,,Other,999.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,999.23,999.23, STENT RENAL BILIARY 5X15X90,C2625,HCPCS,278,RC,,,,both,4134.3,2894.01,,,,,,,,,,,,,,,,,,,Other,891.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,891.36,891.36, STENT RENAL BILIARY 5X19X90,C2625,HCPCS,278,RC,,,,both,4134.3,2894.01,,,,,,,,,,,,,,,,,,,Other,891.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,891.36,891.36, STENT RENAL BILIARY 6X14X90,C2625,HCPCS,278,RC,,,,both,2497.5,1748.25,,,,,,,,,,,,,,,,,,,Other,538.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,538.46,538.46, STENT RENAL BILIARY 6X18X90,C2625,HCPCS,278,RC,,,,both,2497.5,1748.25,,,,,,,,,,,,,,,,,,,Other,538.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,538.46,538.46, STENT RENAL BILIARY 4X19X90,C2625,HCPCS,278,RC,,,,both,4134.3,2894.01,,,,,,,,,,,,,,,,,,,Other,891.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,891.36,891.36, TUBE MINNESOTA 18FR,272,RC,,,,,,both,2247.09,1572.96,,,,,,,,,,,,,,,,,,,Other,484.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,484.47,484.47, REFLUX MANAGEMENT SYSTEM SIZE 13,L8699,HCPCS,278,RC,,,,both,18314.72,12820.3,,,,,,,,,,,,,,,,,,,Other,3948.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3948.66,3948.66, REFLUX MANAGEMENT SYSTEM SIZE 14,L8699,HCPCS,278,RC,,,,both,18314.72,12820.3,,,,,,,,,,,,,,,,,,,Other,3948.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3948.66,3948.66, REFLUX MANAGEMENT SYSTEM SIZE 15,L8699,HCPCS,278,RC,,,,both,18314.72,12820.3,,,,,,,,,,,,,,,,,,,Other,3948.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3948.66,3948.66, REFLUX MANAGEMENT SYSTEM SIZE 16,L8699,HCPCS,278,RC,,,,both,18314.72,12820.3,,,,,,,,,,,,,,,,,,,Other,3948.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3948.66,3948.66, REFLUX MANAGEMENT SYSTEM SIZE 17,L8699,HCPCS,278,RC,,,,both,19335.77,13535.04,,,,,,,,,,,,,,,,,,,Other,4168.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4168.79,4168.79, REFLUX SIZING TOOL,272,RC,,,,,,both,499.5,349.65,,,,,,,,,,,,,,,,,,,Other,107.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,107.69,107.69, TIF SEROSAFUSE IMPLANTABLE CARTRIDGE KIT,L8699,HCPCS,278,RC,,,,both,17765.55,12435.89,,,,,,,,,,,,,,,,,,,Other,3830.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3830.25,3830.25, STENT TRUNK IPSILATERIAL LEG,C2625,HCPCS,278,RC,,,,both,25031.04,17521.73,,,,,,,,,,,,,,,,,,,Other,5396.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5396.69,5396.69, STENT CONTRALATERAL LEG 12MM X 14CM,C1874,HCPCS,278,RC,,,,both,11218.6,7853.02,,,,,,,,,,,,,,,,,,,Other,2418.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2418.73,2418.73, SHEATH INTRODUCER 18FR X 30CM,272,RC,,,,,,both,421.46,295.02,,,,,,,,,,,,,,,,,,,Other,90.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,90.87,90.87, SHEATH INTRODUCER 12FR X 30CM,272,RC,,,,,,both,263.41,184.39,,,,,,,,,,,,,,,,,,,Other,56.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,56.79,56.79, GRAFT AORTIC HEMASHIE 16X30,C1768,HCPCS,278,RC,,,,both,2034.94,1424.46,,,,,,,,,,,,,,,,,,,Other,438.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,438.74,438.74, GRAFT WALL ENDOPROSTHEIS,C1768,HCPCS,278,RC,,,,both,6493.4,4545.38,,,,,,,,,,,,,,,,,,,Other,1399.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1399.98,1399.98, GRAFT WALL ENDOPROSTHEIS 8MM X 30MM,C1768,HCPCS,278,RC,,,,both,6655.73,4659.01,,,,,,,,,,,,,,,,,,,Other,1434.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1434.97,1434.97, GRAFT WALL ENDOPROSTHEIS 8MM X 70MM,C1768,HCPCS,278,RC,,,,both,7492.39,5244.67,,,,,,,,,,,,,,,,,,,Other,1615.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1615.36,1615.36, GRAFT AORTIC HEMASHIE 18X30,C1768,HCPCS,278,RC,,,,both,1864.77,1305.34,,,,,,,,,,,,,,,,,,,Other,402.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,402.04,402.04, GRAFT SURGISIS BIODESIGN 9X14,C1768,HCPCS,278,RC,,,,both,2659.86,1861.9,,,,,,,,,,,,,,,,,,,Other,573.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,573.47,573.47, GRAFT HEMASHIELD 20X3,C1768,HCPCS,278,RC,,,,both,1481.83,1037.28,,,,,,,,,,,,,,,,,,,Other,319.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,319.48,319.48, GRAFT BIFURCATED 14 X 7,C1768,HCPCS,278,RC,,,,both,2167.8,1517.46,,,,,,,,,,,,,,,,,,,Other,467.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,467.38,467.38, GRAFT BIFURCATED 18,C1768,HCPCS,278,RC,,,,both,3287.39,2301.17,,,,,,,,,,,,,,,,,,,Other,708.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,708.77,708.77, CATH SILICONE 16FR 10CC LF,A4344,HCPCS,272,RC,,,,both,21.09,14.76,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, KIT MENISECTOMY BASIC,271,RC,,,,,,both,175.67,122.97,,,,,,,,,,,,,,,,,,,Other,37.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.88,37.88, CATH BRITE TIP 6FR-.070-55CM-MPA-1,C1887,HCPCS,278,RC,,,,both,184.15,128.91,,,,,,,,,,,,,,,,,,,Other,39.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.7,39.7, DNO UROLOCK II ADAPTOR PT CHARGE,C1889,HCPCS,272,RC,,,,both,60.47,42.33,,,,,,,,,,,,,,,,,,,Other,13.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.03,13.03, PT CHG CLOSED SUCTION CATH 14FR TPIECE,272,RC,,,,,,both,49.24,34.47,,,,,,,,,,,,,,,,,,,Other,10.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.61,10.61, OR CHARGE INJECTION NEEDLE 23G 0.4 MM,272,RC,,,,,,both,199.43,139.6,,,,,,,,,,,,,,,,,,,Other,42.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.99,42.99, PT CHARGE TUBE HOLDER ENDOTRACHEAL,272,RC,,,,,,both,68.83,48.18,,,,,,,,,,,,,,,,,,,Other,14.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.84,14.84, ELECTRODE POLYHESIVE (PT CHG),A4556,HCPCS,270,RC,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, BLADE DERMABLADE BIOPSY (PT CHG),272,RC,,,,,,both,20.6,14.42,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.44,4.44, PT CHG LOOP RED MAXI RED 18IN,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, PT CHG LOOP BLUE MINI DEVO,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, PT CHG SENSOR OXYGEN ADULT/CHILD MAX-N,272,RC,,,,,,both,32.99,23.09,,,,,,,,,,,,,,,,,,,Other,7.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.11,7.11, HANDPIECE INTERPULSE W/HIGH FLOW TI,71,RC,,,,,,both,121.5,85.05,,,,,,,,,,,,,,,,,,,Other,26.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.2,26.2, DILATOR MALONEY 46FR BOUGIE,272,RC,,,,,,both,764.57,535.2,,,,,,,,,,,,,,,,,,,Other,164.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,164.85,164.85, DILATOR MALONEY 42FR BOUGIE,272,RC,,,,,,both,715.62,500.93,,,,,,,,,,,,,,,,,,,Other,154.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,154.29,154.29, SUTURE ANCHOR 4.5 GROSS FT.,272,RC,,,,,,both,807.81,565.47,,,,,,,,,,,,,,,,,,,Other,174.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,174.17,174.17, TROCHANTERIC NAIL KIT 180 TI GAMMA 3,C1713,HCPCS,278,RC,,,,both,3696.24,2587.37,,,,,,,,,,,,,,,,,,,Other,796.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,796.91,796.91, LAG SCREW TI GAMMA 3,C1713,HCPCS,278,RC,,,,both,1398.58,979.01,,,,,,,,,,,,,,,,,,,Other,301.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,301.54,301.54, LOCKING SCREW FULLY THREADED,C1713,HCPCS,278,RC,,,,both,580.24,406.17,,,,,,,,,,,,,,,,,,,Other,125.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,125.1,125.1, K-WIRE,C1769,HCPCS,278,RC,,,,both,333,233.1,,,,,,,,,,,,,,,,,,,Other,71.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.79,71.79, GUIDE WIRE BALL TIPPED STERILE,C1769,HCPCS,278,RC,,,,both,582.74,407.92,,,,,,,,,,,,,,,,,,,Other,125.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,125.64,125.64, GUIDE WIRE PARTIALLY THREADED,C1769,HCPCS,278,RC,,,,both,86.1,60.27,,,,,,,,,,,,,,,,,,,Other,18.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.56,18.56, ULTRAVERSE 035 7.0MM X 150MM,C1725,HCPCS,278,RC,,,,both,316.35,221.45,,,,,,,,,,,,,,,,,,,Other,68.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.21,68.21, ULTRAVERSE 035 4.0MMX80MM,C1725,HCPCS,278,RC,,,,both,316.35,221.45,,,,,,,,,,,,,,,,,,,Other,68.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.21,68.21, GRAFT 10/10 BTB,C1768,HCPCS,278,RC,,,,both,11987.82,8391.47,,,,,,,,,,,,,,,,,,,Other,2584.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2584.57,2584.57, PLATE LCP VOLAR DISTAL RADIUS 4H RIGHT,C1713,HCPCS,278,RC,,,,both,2467.49,1727.24,,,,,,,,,,,,,,,,,,,Other,531.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,531.99,531.99, SCREW 2.4 LOCKING SLF-TPNG 14MM RECESS,C1713,HCPCS,278,RC,,,,both,346.31,242.42,,,,,,,,,,,,,,,,,,,Other,74.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,74.67,74.67, SCREW 2.4 LOCKING SLF-TPNG 22MM RECESS,C1713,HCPCS,278,RC,,,,both,346.31,242.42,,,,,,,,,,,,,,,,,,,Other,74.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,74.67,74.67, SCREW 2.4 LOCKING SLF-TPNG 24MM RECESS,C1713,HCPCS,278,RC,,,,both,346.31,242.42,,,,,,,,,,,,,,,,,,,Other,74.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,74.67,74.67, SCREW 2.4 CORTEX SLF-TPNG 14MM RECESS,C1713,HCPCS,278,RC,,,,both,198.85,139.2,,,,,,,,,,,,,,,,,,,Other,42.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.88,42.88, SCREW LAG 2.4MM X 16MM X 2,C1713,HCPCS,278,RC,,,,both,499.49,349.64,,,,,,,,,,,,,,,,,,,Other,107.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,107.69,107.69, ULTRAVERSE 035 4.0MMX60MM,C1725,HCPCS,278,RC,,,,both,316.35,221.45,,,,,,,,,,,,,,,,,,,Other,68.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.21,68.21, LUTONIX 035 DCB 5F,C1725,HCPCS,278,RC,,,,both,4162.44,2913.71,,,,,,,,,,,,,,,,,,,Other,897.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,897.43,897.43, SCREW 3.5 X 10MM LOCKING CORTICAL SC,C1713,HCPCS,278,RC,,,,both,283.05,198.14,,,,,,,,,,,,,,,,,,,Other,61.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.02,61.02, SCREW 3.5 X 8MM LOCKING CORTICAL SC,C1713,HCPCS,278,RC,,,,both,283.05,198.14,,,,,,,,,,,,,,,,,,,Other,61.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.02,61.02, SCREW 2.3X20MM THREADED LOCKING,C1713,HCPCS,278,RC,,,,both,290.13,203.09,,,,,,,,,,,,,,,,,,,Other,62.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,62.55,62.55, SCREW 3.5X12.0 MM CORTICAL SCREW,C1713,HCPCS,278,RC,,,,both,112.5,78.75,,,,,,,,,,,,,,,,,,,Other,24.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.26,24.26, SCREW 3.5 X 12MM LOCKING CORTICAL SC,C1713,HCPCS,278,RC,,,,both,283.05,198.14,,,,,,,,,,,,,,,,,,,Other,61.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.02,61.02, SCREW 2.3X24MM THREADED LOCKING,C1713,HCPCS,278,RC,,,,both,283.05,198.14,,,,,,,,,,,,,,,,,,,Other,61.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.02,61.02, SCREW 2.3X22MM THREADED LOCKING,C1713,HCPCS,278,RC,,,,both,283.05,198.14,,,,,,,,,,,,,,,,,,,Other,61.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.02,61.02, SCREW 3.5 X 16MM CORTICAL,C1713,HCPCS,278,RC,,,,both,112.5,78.75,,,,,,,,,,,,,,,,,,,Other,24.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.26,24.26, SCREW 3.5 X 18MM CORTICAL,C1713,HCPCS,278,RC,,,,both,249.75,174.83,,,,,,,,,,,,,,,,,,,Other,53.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,53.85,53.85, SCREW 3.5 X 14MM CORTICAL,C1713,HCPCS,278,RC,,,,both,112.5,78.75,,,,,,,,,,,,,,,,,,,Other,24.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.26,24.26, SCREW SUPER REVO SUTURE ANCHOR KIT,C1713,HCPCS,278,RC,,,,both,716.77,501.74,,,,,,,,,,,,,,,,,,,Other,154.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,154.54,154.54, ULTRAVERSE 03550 MM X 60MMX130CM,C1725,HCPCS,278,RC,,,,both,316.35,221.45,,,,,,,,,,,,,,,,,,,Other,68.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.21,68.21, SCREW 2.7 CORTEX 16MM,C1713,HCPCS,278,RC,,,,both,140.42,98.29,,,,,,,,,,,,,,,,,,,Other,30.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,30.27,30.27, SCREW 2.4 CORTEX 20MM,C1713,HCPCS,278,RC,,,,both,366.29,256.4,,,,,,,,,,,,,,,,,,,Other,78.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,78.97,78.97, SCREW 2.4 CORTEX 24MM,C1713,HCPCS,278,RC,,,,both,366.29,256.4,,,,,,,,,,,,,,,,,,,Other,78.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,78.97,78.97, SCREW 2.4 CORTEX 26MM,C1713,HCPCS,278,RC,,,,both,366.29,256.4,,,,,,,,,,,,,,,,,,,Other,78.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,78.97,78.97, SCREW 2.4 CORTEX 28MM,C1713,HCPCS,278,RC,,,,both,366.29,256.4,,,,,,,,,,,,,,,,,,,Other,78.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,78.97,78.97, SCREW 2.4 LOCKING 18MM,C1713,HCPCS,278,RC,,,,both,366.29,256.4,,,,,,,,,,,,,,,,,,,Other,78.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,78.97,78.97, SCREW 2.7 CORTEX 14MM,C1713,HCPCS,278,RC,,,,both,140.42,98.29,,,,,,,,,,,,,,,,,,,Other,30.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,30.27,30.27, SCREW 3.5 LOCKING 36MM,C1713,HCPCS,278,RC,,,,both,392.93,275.05,,,,,,,,,,,,,,,,,,,Other,84.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,84.71,84.71, SCREW3.5 LOCKING 50MM,C1713,HCPCS,278,RC,,,,both,392.93,275.05,,,,,,,,,,,,,,,,,,,Other,84.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,84.71,84.71, SCREW 3.5 CORTEX 30MM,C1713,HCPCS,278,RC,,,,both,94.3,66.01,,,,,,,,,,,,,,,,,,,Other,20.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.34,20.34, LUTONIX 035 5.0MM X 60MM,C1725,HCPCS,278,RC,,,,both,4162.44,2913.71,,,,,,,,,,,,,,,,,,,Other,897.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,897.43,897.43, SCREW LAG VHS W/COMP SCREW,C1713,HCPCS,278,RC,,,,both,935.72,655,,,,,,,,,,,,,,,,,,,Other,201.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,201.74,201.74, SCREW 3.5 CORTEX12MM,C1713,HCPCS,278,RC,,,,both,103.52,72.46,,,,,,,,,,,,,,,,,,,Other,22.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.31,22.31, SCREW 4.0 CORTEX16MM,C1713,HCPCS,278,RC,,,,both,90.2,63.14,,,,,,,,,,,,,,,,,,,Other,19.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.44,19.44, SCREW 4.0 CORTEX18MM,C1713,HCPCS,278,RC,,,,both,88.25,61.78,,,,,,,,,,,,,,,,,,,Other,19.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.03,19.03, SCREW 4.0 CORTEX20MM,C1713,HCPCS,278,RC,,,,both,86.1,60.27,,,,,,,,,,,,,,,,,,,Other,18.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.56,18.56, SCREW LAG VHS W/COMP SCREW,C1713,HCPCS,278,RC,,,,both,1102.21,771.55,,,,,,,,,,,,,,,,,,,Other,237.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,237.64,237.64, SCREW LAG VHS W/COMP SCREW,C1713,HCPCS,278,RC,,,,both,1102.21,771.55,,,,,,,,,,,,,,,,,,,Other,237.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,237.64,237.64, SCREW 4.0 CORTEX18MM,C1713,HCPCS,278,RC,,,,both,90.2,63.14,,,,,,,,,,,,,,,,,,,Other,19.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.44,19.44, LUTONIX 035 4.0MM X 60MM,C1725,HCPCS,278,RC,,,,both,4162.44,2913.71,,,,,,,,,,,,,,,,,,,Other,897.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,897.43,897.43, FIXATION PINS SET OF 3,C1713,HCPCS,278,RC,,,,both,832.49,582.74,,,,,,,,,,,,,,,,,,,Other,179.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,179.49,179.49, ULTRAVERSE 035 5.0MMX40MM,C1725,HCPCS,278,RC,,,,both,325.52,227.86,,,,,,,,,,,,,,,,,,,Other,70.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,70.18,70.18, ULTRAVERSE 035 6.0MM X 40MM,C1725,HCPCS,278,RC,,,,both,325.52,227.86,,,,,,,,,,,,,,,,,,,Other,70.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,70.18,70.18, LUTONIX 035 6.0MM X 100MM,C1725,HCPCS,278,RC,,,,both,5535.15,3874.61,,,,,,,,,,,,,,,,,,,Other,1193.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1193.38,1193.38, LUTONIX 035 5.0MM X 40MM,C1725,HCPCS,278,RC,,,,both,5535.15,3874.61,,,,,,,,,,,,,,,,,,,Other,1193.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1193.38,1193.38, KIT RADIUS DISTAL,278,RC,,,,,,both,8780.46,6146.32,,,,,,,,,,,,,,,,,,,Other,1893.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1893.07,1893.07, ULTRAVERSE 035 6.0MM X 80MM,C1725,HCPCS,272,RC,,,,both,325.52,227.86,,,,,,,,,,,,,,,,,,,Other,70.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,70.18,70.18, LUTONIX 035 6.0MM X 60MM,C1725,HCPCS,278,RC,,,,both,4162.44,2913.71,,,,,,,,,,,,,,,,,,,Other,897.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,897.43,897.43, KIT RADIUS DISTAL,278,RC,,,,,,both,8780.46,6146.32,,,,,,,,,,,,,,,,,,,Other,1893.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1893.07,1893.07, LUTONIX 035 7.0MM X 60MM,C1725,HCPCS,278,RC,,,,both,4162.44,2913.71,,,,,,,,,,,,,,,,,,,Other,897.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,897.43,897.43, SCREW PROPEL 9X30MM I/F,C1713,HCPCS,278,RC,,,,both,333,233.1,,,,,,,,,,,,,,,,,,,Other,71.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.79,71.79, SCREW CANNULATED 2.4 10MM,C1713,HCPCS,278,RC,,,,both,749.24,524.47,,,,,,,,,,,,,,,,,,,Other,161.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,161.53,161.53, SCREW CANNULATED 2.4 16MM,C1713,HCPCS,278,RC,,,,both,749.24,524.47,,,,,,,,,,,,,,,,,,,Other,161.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,161.53,161.53, SCREW CANNULATED 2.4 15MM,C1713,HCPCS,278,RC,,,,both,749.24,524.47,,,,,,,,,,,,,,,,,,,Other,161.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,161.53,161.53, SCREW CANNULATED 2.4 14MM,C1713,HCPCS,278,RC,,,,both,767.97,537.58,,,,,,,,,,,,,,,,,,,Other,165.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,165.57,165.57, GUARDSMAN FEM IFS 9X30MM,C1713,HCPCS,278,RC,,,,both,341.32,238.92,,,,,,,,,,,,,,,,,,,Other,73.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,73.59,73.59, SUTURE ANCHOR TITANIUM 4.0MM,C1713,HCPCS,278,RC,,,,both,853.3,597.31,,,,,,,,,,,,,,,,,,,Other,183.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,183.98,183.98, LUTONIX 035 5.0MM X 60MM,C1725,HCPCS,278,RC,,,,both,4283.15,2998.21,,,,,,,,,,,,,,,,,,,Other,923.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,923.44,923.44, BIO A TISSUE REINFORCEMENT 8X8,C1781,HCPCS,278,RC,,,,both,1541.79,1079.25,,,,,,,,,,,,,,,,,,,Other,332.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,332.41,332.41, ULTRAVERSE 035 4.0MMX40MM,C1725,HCPCS,278,RC,,,,both,325.52,227.86,,,,,,,,,,,,,,,,,,,Other,70.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,70.18,70.18, CONGRUENT TRIBIAL INSERT 1/2 14MM RT,278,RC,,,,,,both,5113.74,3579.62,,,,,,,,,,,,,,,,,,,Other,1102.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1102.52,1102.52, CONGRUENT TRIBIAL INSERT 1/2 12MM RT,278,RC,,,,,,both,3972.27,2780.59,,,,,,,,,,,,,,,,,,,Other,856.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,856.42,856.42, CONGRUENT TIBIAL INSERT,278,RC,,,,,,both,3972.27,2780.59,,,,,,,,,,,,,,,,,,,Other,856.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,856.42,856.42, CONGRUENT TIBIAL INSERT SIZE 5/6 12MM RT,278,RC,,,,,,both,4460.48,3122.34,,,,,,,,,,,,,,,,,,,Other,961.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,961.68,961.68, DNO LUTONIX 035 5.0MMX100MM,C1725,HCPCS,278,RC,,,,both,4162.44,2913.71,,,,,,,,,,,,,,,,,,,Other,897.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,897.43,897.43, LUTONIX 035 5.0MM X 150MM,C1725,HCPCS,278,RC,,,,both,4994.93,3496.45,,,,,,,,,,,,,,,,,,,Other,1076.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1076.9,1076.9, LUTONIX 035 5F,C1725,HCPCS,278,RC,,,,both,4162.44,2913.71,,,,,,,,,,,,,,,,,,,Other,897.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,897.43,897.43, LUTONIX 035 DCB 5F,C1725,HCPCS,278,RC,,,,both,5659.34,3961.54,,,,,,,,,,,,,,,,,,,Other,1220.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1220.15,1220.15, BIO A TISSUE REINFORCEMENT 10X30,C1781,HCPCS,278,RC,,,,both,6730.83,4711.58,,,,,,,,,,,,,,,,,,,Other,1451.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1451.16,1451.16, BIO A TISSUE REINFORCEMENT 20X30,C1781,HCPCS,278,RC,,,,both,12642.68,8849.88,,,,,,,,,,,,,,,,,,,Other,2725.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2725.76,2725.76, ULTRAVERSE 035 4.0MMX100MM,C1725,HCPCS,278,RC,,,,both,316.35,221.45,,,,,,,,,,,,,,,,,,,Other,68.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.21,68.21, ULTRAVERSE 035 5.0 MM X 100MM,C1725,HCPCS,278,RC,,,,both,316.35,221.45,,,,,,,,,,,,,,,,,,,Other,68.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.21,68.21, LUTONIX035DCB5F,C1725,HCPCS,278,RC,,,,both,4994.93,3496.45,,,,,,,,,,,,,,,,,,,Other,1076.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1076.9,1076.9, BASEPLATE CCM STEM TIBIAL SIZE 4 RIGHT,278,RC,,,,,,both,8938.5,6256.95,,,,,,,,,,,,,,,,,,,Other,1927.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1927.14,1927.14, BASEPLATE CCM STEM TIBIAL SIZE 3 LEFT,278,RC,,,,,,both,8766.41,6136.49,,,,,,,,,,,,,,,,,,,Other,1890.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1890.04,1890.04, LUTONIX035DCB5F,C1725,HCPCS,278,RC,,,,both,4162.44,2913.71,,,,,,,,,,,,,,,,,,,Other,897.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,897.43,897.43, SCREW FEMORAL 8MM X 25MM,C1713,HCPCS,278,RC,,,,both,341.32,238.92,,,,,,,,,,,,,,,,,,,Other,73.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,73.59,73.59, SCREW PROPEL TIBIAL,C1713,HCPCS,278,RC,,,,both,341.32,238.92,,,,,,,,,,,,,,,,,,,Other,73.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,73.59,73.59, ULTRAVERSE 035 7.0MM X 40MM,C1725,HCPCS,278,RC,,,,both,316.35,221.45,,,,,,,,,,,,,,,,,,,Other,68.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.21,68.21, LUTONIX 035 5.0MM X 40MM 130CM,C1725,HCPCS,278,RC,,,,both,4162.44,2913.71,,,,,,,,,,,,,,,,,,,Other,897.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,897.43,897.43, PIN GUIDE 2.5MM,278,RC,,,,,,both,312.59,218.81,,,,,,,,,,,,,,,,,,,Other,67.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,67.39,67.39, POST TAPER HEMICAP 15.6MM,278,RC,,,,,,both,2528.77,1770.14,,,,,,,,,,,,,,,,,,,Other,545.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,545.2,545.2, ARTICULAR HEMICAP 52MMX48MM,278,RC,,,,,,both,17806.76,12464.73,,,,,,,,,,,,,,,,,,,Other,3839.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3839.14,3839.14, ANCHOR SUTURE TITANIUM 5.5 MM,278,RC,,,,,,both,1000.98,700.69,,,,,,,,,,,,,,,,,,,Other,215.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,215.82,215.82, SCREW 6.5X40MM EXTENDED TAB,278,RC,,,,,,both,6017.78,4212.45,,,,,,,,,,,,,,,,,,,Other,1297.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1297.43,1297.43, ANCHOR SUTURE PEEK 5.5MM,278,RC,,,,,,both,1362.73,953.91,,,,,,,,,,,,,,,,,,,Other,293.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,293.8,293.8, ROD 6X40MM,278,RC,,,,,,both,1196.24,837.37,,,,,,,,,,,,,,,,,,,Other,257.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,257.91,257.91, SET SCREW,278,RC,,,,,,both,868.64,608.05,,,,,,,,,,,,,,,,,,,Other,187.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,187.28,187.28, SCREW 6.5X35MM EXTENDED TAB,278,RC,,,,,,both,6017.78,4212.45,,,,,,,,,,,,,,,,,,,Other,1297.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1297.43,1297.43, GUIDE WIRE,278,RC,,,,,,both,482.92,338.04,,,,,,,,,,,,,,,,,,,Other,104.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,104.12,104.12, PLATE NARROW VOLAR DISTAL RADIOUS RT,C1713,HCPCS,278,RC,,,,both,2730.56,1911.39,,,,,,,,,,,,,,,,,,,Other,588.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,588.71,588.71, PLATE NARROW VOLAR DISTAL RADIUS RT,C1713,HCPCS,278,RC,,,,both,2730.56,1911.39,,,,,,,,,,,,,,,,,,,Other,588.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,588.71,588.71, PLATE DISTAL RADIUS RT STANDARD,C1713,HCPCS,278,RC,,,,both,2730.56,1911.39,,,,,,,,,,,,,,,,,,,Other,588.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,588.71,588.71, PLATE DISTAL RADIUS FIBULA LT 4H 86MM,C1713,HCPCS,278,RC,,,,both,2269.78,1588.85,,,,,,,,,,,,,,,,,,,Other,489.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,489.36,489.36, JASHIDI NEEDLE,272,RC,,,,,,both,570.72,399.5,,,,,,,,,,,,,,,,,,,Other,123.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,123.05,123.05, ARTICULATING CAGE 11X30X9,278,RC,,,,,,both,11414.59,7990.21,,,,,,,,,,,,,,,,,,,Other,2460.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2460.99,2460.99, ARTICULATING CAGE 11X30X10,278,RC,,,,,,both,11414.59,7990.21,,,,,,,,,,,,,,,,,,,Other,2460.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2460.99,2460.99, SCREW 6.5X40MM EXTENDED TAB,278,RC,,,,,,both,6017.78,4212.45,,,,,,,,,,,,,,,,,,,Other,1297.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1297.43,1297.43, JASHIDI NEEDLE,272,RC,,,,,,both,570.72,399.5,,,,,,,,,,,,,,,,,,,Other,123.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,123.05,123.05, GUIDE WIRE,C1769,HCPCS,278,RC,,,,both,469.31,328.52,,,,,,,,,,,,,,,,,,,Other,101.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,101.18,101.18, SCREW 6.5X45 TIGER MIS,278,RC,,,,,,both,6017.78,4212.45,,,,,,,,,,,,,,,,,,,Other,1297.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1297.43,1297.43, SCREW 6.5X40 TIGER MIS,278,RC,,,,,,both,6017.78,4212.45,,,,,,,,,,,,,,,,,,,Other,1297.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1297.43,1297.43, SET SCREW,278,RC,,,,,,both,868.64,608.05,,,,,,,,,,,,,,,,,,,Other,187.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,187.28,187.28, ROD MIS 5.5X45MM,278,RC,,,,,,both,1196.24,837.37,,,,,,,,,,,,,,,,,,,Other,257.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,257.91,257.91, ARTICULATING CAGE 30X11X11,278,RC,,,,,,both,11414.59,7990.21,,,,,,,,,,,,,,,,,,,Other,2460.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2460.99,2460.99, SCREW 6.5X50MM EXTENDED TAB,278,RC,,,,,,both,6017.78,4212.45,,,,,,,,,,,,,,,,,,,Other,1297.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1297.43,1297.43, SCREW 6.5X45MM EXTENDED TAB,278,RC,,,,,,both,6017.78,4212.45,,,,,,,,,,,,,,,,,,,Other,1297.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1297.43,1297.43, GUIDE WIRE,278,RC,,,,,,both,482.92,338.04,,,,,,,,,,,,,,,,,,,Other,104.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,104.12,104.12, OSTEO-SITE NEEDLE BIOPSY BONE,272,RC,,,,,,both,1352.19,946.53,,,,,,,,,,,,,,,,,,,Other,291.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,291.53,291.53, COTTON WEDGE 7MM,C1713,HCPCS,278,RC,,,,both,8277.01,5793.91,,,,,,,,,,,,,,,,,,,Other,1784.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1784.52,1784.52, EVANS WEDGE 10MM,C1713,HCPCS,278,RC,,,,both,9471.63,6630.14,,,,,,,,,,,,,,,,,,,Other,2042.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2042.08,2042.08, DRILL 2.0X110MM SOLID MEASURING AO,C1713,HCPCS,272,RC,,,,both,1058.09,740.66,,,,,,,,,,,,,,,,,,,Other,228.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,228.12,228.12, K-WIRE SINGLE ENDED TROCAR TIP SMOOTH 2.,C1713,HCPCS,278,RC,,,,both,168.1,117.67,,,,,,,,,,,,,,,,,,,Other,36.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.24,36.24, OLIVE WIRE SMOOTH 1.4MM,C1713,HCPCS,278,RC,,,,both,580.24,406.17,,,,,,,,,,,,,,,,,,,Other,125.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,125.1,125.1, R3CON LOCKING PLATE SCREW 2.7X18,C1713,HCPCS,278,RC,,,,both,1058.09,740.66,,,,,,,,,,,,,,,,,,,Other,228.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,228.12,228.12, R3CON NON-LOCKING PLATE SCREW 2.7X12MM,C1713,HCPCS,278,RC,,,,both,819.17,573.42,,,,,,,,,,,,,,,,,,,Other,176.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,176.62,176.62, R3CON NON-LOCKING PLATE SCREQ 2.7X14MM,C1713,HCPCS,278,RC,,,,both,819.17,573.42,,,,,,,,,,,,,,,,,,,Other,176.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,176.62,176.62, HEVANS PLATE MEDOIUM LEFT 20MM,C1713,HCPCS,278,RC,,,,both,7509.04,5256.33,,,,,,,,,,,,,,,,,,,Other,1618.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1618.95,1618.95, "DRILL 4.6X220MM CANNULATED 3/16"" SQ CONN",C1713,HCPCS,278,RC,,,,both,1279.95,895.97,,,,,,,,,,,,,,,,,,,Other,275.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,275.96,275.96, K-WIRE SINGLE TROCAR TIP SMOOTH W/ FLOUR,C1713,HCPCS,278,RC,,,,both,511.98,358.39,,,,,,,,,,,,,,,,,,,Other,110.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,110.39,110.39, MONSTER CANNULATED MEDIUM THREAD SCREW H,C1713,HCPCS,278,RC,,,,both,4420.1,3094.07,,,,,,,,,,,,,,,,,,,Other,952.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,952.97,952.97, MONSTER CANNULATED MEDIUM THREADED SCREW,C1713,HCPCS,278,RC,,,,both,4420.1,3094.07,,,,,,,,,,,,,,,,,,,Other,952.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,952.97,952.97, LUTONIX 035 4MM X 40MM 130CM,C1725,HCPCS,278,RC,,,,both,4162.44,2913.71,,,,,,,,,,,,,,,,,,,Other,897.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,897.43,897.43, 3.5MM CORTICAL SCREW SELF-TAP SMALL HEX,C1713,HCPCS,278,RC,,,,both,103.11,72.18,,,,,,,,,,,,,,,,,,,Other,22.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.23,22.23, CRUSHED CANCELLOUS CHIPS 15CC 1-4MM,C1713,HCPCS,278,RC,,,,both,1952.35,1366.65,,,,,,,,,,,,,,,,,,,Other,420.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,420.93,420.93, GUIDE WIRE,C1769,HCPCS,278,RC,,,,both,469.31,328.52,,,,,,,,,,,,,,,,,,,Other,101.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,101.18,101.18, DRILL 2.4X140MM SOLID MEASURING LONG AO,C1713,HCPCS,278,RC,,,,both,1058.09,740.66,,,,,,,,,,,,,,,,,,,Other,228.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,228.12,228.12, ULTRAVERSE 035 5.0 MM X 150MM,C1725,HCPCS,278,RC,,,,both,316.35,221.45,,,,,,,,,,,,,,,,,,,Other,68.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.21,68.21, MTP PLATE SHORT-SHORT LEFT 2-HOLE DISTAL,C1713,HCPCS,278,RC,,,,both,8072.21,5650.55,,,,,,,,,,,,,,,,,,,Other,1740.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1740.37,1740.37, K-WIRE SINGLE ENDED TROCAR TIP SMOOTH 1.,C1713,HCPCS,278,RC,,,,both,176.5,123.55,,,,,,,,,,,,,,,,,,,Other,38.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,38.05,38.05, R3CON LOCKING PLATE SCREW 3.5X20MM,C1713,HCPCS,278,RC,,,,both,1126.35,788.45,,,,,,,,,,,,,,,,,,,Other,242.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,242.84,242.84, R3CON LOCKING PLATE SCREW 3.5X20MM,C1713,HCPCS,278,RC,,,,both,1126.35,788.45,,,,,,,,,,,,,,,,,,,Other,242.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,242.84,242.84, R3CON NON-LOCKING PLATE SCREW 3.5X14MM,C1713,HCPCS,278,RC,,,,both,819.17,573.42,,,,,,,,,,,,,,,,,,,Other,176.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,176.62,176.62, R3CON NON-LOCKING PLATE SCREW 3.5X16MM,C1713,HCPCS,278,RC,,,,both,819.17,573.42,,,,,,,,,,,,,,,,,,,Other,176.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,176.62,176.62, R3CON NON-LOCKING PLATE SCREW 3.5X20MM,C1713,HCPCS,278,RC,,,,both,819.17,573.42,,,,,,,,,,,,,,,,,,,Other,176.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,176.62,176.62, MINI-MONSTER CANNULATED SHORT THREAD SCR,C1713,HCPCS,278,RC,,,,both,1416.48,991.54,,,,,,,,,,,,,,,,,,,Other,305.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,305.4,305.4, COUNTERSINK 3.5MM HEADLESS,C1713,HCPCS,278,RC,,,,both,1058.09,740.66,,,,,,,,,,,,,,,,,,,Other,228.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,228.12,228.12, DRILL 2.3X120MM CANNULATED AO,C1713,HCPCS,278,RC,,,,both,1058.09,740.66,,,,,,,,,,,,,,,,,,,Other,228.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,228.12,228.12, K-WIRE SINGLE ENDED TROCAR TIP SMOOTH 1.,C1713,HCPCS,278,RC,,,,both,176.5,123.55,,,,,,,,,,,,,,,,,,,Other,38.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,38.05,38.05, PIN 33MM HEADED,278,RC,,,,,,both,386.34,270.44,,,,,,,,,,,,,,,,,,,Other,83.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,83.29,83.29, PIN,278,RC,,,,,,both,449.56,314.69,,,,,,,,,,,,,,,,,,,Other,96.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,96.92,96.92, PIN TENSION BAND 70CM,278,RC,,,,,,both,403.89,282.72,,,,,,,,,,,,,,,,,,,Other,87.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,87.08,87.08, LUTONIX 035 5X80,C1725,HCPCS,278,RC,,,,both,4162.44,2913.71,,,,,,,,,,,,,,,,,,,Other,897.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,897.43,897.43, LUTONIX 035 5X80,C1725,HCPCS,278,RC,,,,both,4162.44,2913.71,,,,,,,,,,,,,,,,,,,Other,897.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,897.43,897.43, LUTONIX 035 4X60 5F,C1725,HCPCS,278,RC,,,,both,4162.44,2913.71,,,,,,,,,,,,,,,,,,,Other,897.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,897.43,897.43, LUTONIX 035 4X80 5F,C1725,HCPCS,278,RC,,,,both,4162.44,2913.71,,,,,,,,,,,,,,,,,,,Other,897.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,897.43,897.43, ULTRAVERSE 035 6.0MM X 100MM,C1725,HCPCS,278,RC,,,,both,316.35,221.45,,,,,,,,,,,,,,,,,,,Other,68.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.21,68.21, ULTRAVERSE 035 7.0MM X 100MM,C1725,HCPCS,278,RC,,,,both,316.35,221.45,,,,,,,,,,,,,,,,,,,Other,68.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.21,68.21, ULTRAVERSE 035 7.0MM X 80MM,C1725,HCPCS,278,RC,,,,both,316.35,221.45,,,,,,,,,,,,,,,,,,,Other,68.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.21,68.21, ULTRAVERSE 035 7.0MM X 150MM,C1725,HCPCS,278,RC,,,,both,316.35,221.45,,,,,,,,,,,,,,,,,,,Other,68.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.21,68.21, HEAD RESURFACING 50X16,278,RC,,,,,,both,19625.19,13737.63,,,,,,,,,,,,,,,,,,,Other,4231.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4231.19,4231.19, ULTRAVERSE 035 6.0MM X 120MM,C1725,HCPCS,278,RC,,,,both,316.35,221.45,,,,,,,,,,,,,,,,,,,Other,68.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.21,68.21, ULTRAVERSE 035 6.0MM X 60MM,C1725,HCPCS,278,RC,,,,both,316.35,221.45,,,,,,,,,,,,,,,,,,,Other,68.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.21,68.21, ULTRAVERSE 035 5.0MM X 120MM,C1725,HCPCS,278,RC,,,,both,316.35,221.45,,,,,,,,,,,,,,,,,,,Other,68.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.21,68.21, ULTRAVERSE 035 5.0MM X 80MM,C1725,HCPCS,278,RC,,,,both,316.35,221.45,,,,,,,,,,,,,,,,,,,Other,68.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.21,68.21, ULTRAVERSE 035 4.0MM X 150MM,C1725,HCPCS,278,RC,,,,both,316.35,221.45,,,,,,,,,,,,,,,,,,,Other,68.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.21,68.21, ULTRAVERSE 035 4.0MM X 120MM,C1725,HCPCS,278,RC,,,,both,316.35,221.45,,,,,,,,,,,,,,,,,,,Other,68.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.21,68.21, MINI-MONSTER CANNULATED SHORT THREADED S,C1713,HCPCS,278,RC,,,,both,1194.62,836.23,,,,,,,,,,,,,,,,,,,Other,257.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,257.56,257.56, R3CON NON-LOCKING PLATE SCREW 2.7X16MM,C1713,HCPCS,278,RC,,,,both,819.17,573.42,,,,,,,,,,,,,,,,,,,Other,176.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,176.62,176.62, R3CON NON-LOCKING PLATE SCREW 2.7X15MM,C1713,HCPCS,278,RC,,,,both,819.17,573.42,,,,,,,,,,,,,,,,,,,Other,176.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,176.62,176.62, R3CON LOCKING PLATE SCREW 2.7X15MM,C1713,HCPCS,278,RC,,,,both,1126.35,788.45,,,,,,,,,,,,,,,,,,,Other,242.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,242.84,242.84, R3CON LOCKING PLATE SCREW 2.7X12MM,C1713,HCPCS,278,RC,,,,both,1126.35,788.45,,,,,,,,,,,,,,,,,,,Other,242.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,242.84,242.84, MTP PLATE 0 DEGREE LONG RIGHT,C1713,HCPCS,278,RC,,,,both,8072.21,5650.55,,,,,,,,,,,,,,,,,,,Other,1740.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1740.37,1740.37, MTP SPIN GUARD FEMALE REAMER 19MM,C1713,HCPCS,278,RC,,,,both,2218.58,1553.01,,,,,,,,,,,,,,,,,,,Other,478.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,478.33,478.33, MTP DISC 19X5MM,C1762,HCPCS,278,RC,,,,both,12543.51,8780.46,,,,,,,,,,,,,,,,,,,Other,2704.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2704.38,2704.38, MESH XL 10X14,C1781,HCPCS,278,RC,,,,both,6126.69,4288.68,,,,,,,,,,,,,,,,,,,Other,1320.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1320.91,1320.91, MESH XL 8X12,C1781,HCPCS,278,RC,,,,both,4693.15,3285.21,,,,,,,,,,,,,,,,,,,Other,1011.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1011.84,1011.84, MESH OVAL 6X9IN,C1781,HCPCS,278,RC,,,,both,3020.69,2114.48,,,,,,,,,,,,,,,,,,,Other,651.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,651.26,651.26, MESH RECTANGLE 4X6IN,C1781,HCPCS,278,RC,,,,both,1279.95,895.97,,,,,,,,,,,,,,,,,,,Other,275.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,275.96,275.96, MESH SQUARE 5X5IN,C1781,HCPCS,278,RC,,,,both,1416.48,991.54,,,,,,,,,,,,,,,,,,,Other,305.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,305.4,305.4, MESH HERNIA,C1781,HCPCS,278,RC,,,,both,4095.84,2867.09,,,,,,,,,,,,,,,,,,,Other,883.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,883.06,883.06, MESH HERNIA,C1781,HCPCS,278,RC,,,,both,2559.9,1791.93,,,,,,,,,,,,,,,,,,,Other,551.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,551.92,551.92, MESH HERNIA,C1781,HCPCS,278,RC,,,,both,1757.79,1230.45,,,,,,,,,,,,,,,,,,,Other,378.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,378.98,378.98, MESH HERNIA,C1781,HCPCS,278,RC,,,,both,1928.46,1349.92,,,,,,,,,,,,,,,,,,,Other,415.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,415.77,415.77, MESH HERNIA,C1781,HCPCS,278,RC,,,,both,2832.96,1983.07,,,,,,,,,,,,,,,,,,,Other,610.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.78,610.78, MESH,C1781,HCPCS,278,RC,,,,both,2480.54,1736.38,,,,,,,,,,,,,,,,,,,Other,534.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,534.81,534.81, "MESH VENTRALIGHT ST ECHO 4.5""",C1781,HCPCS,278,RC,,,,both,3988.32,2791.82,,,,,,,,,,,,,,,,,,,Other,859.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,859.88,859.88, "MESH VENTRALIGHT ST WITH ECHO 6""",C1781,HCPCS,278,RC,,,,both,4758,3330.6,,,,,,,,,,,,,,,,,,,Other,1025.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1025.82,1025.82, MESH VENTRALIGHT ST WITH ECHO 10x15CM,C1781,HCPCS,278,RC,,,,both,13925.85,9748.1,,,,,,,,,,,,,,,,,,,Other,3002.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3002.42,3002.42, MESH VENTRALIGHT ST WITH ECHO 15CM CIRCL,C1781,HCPCS,278,RC,,,,both,2992.01,2094.41,,,,,,,,,,,,,,,,,,,Other,645.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,645.08,645.08, MESH VENTRALIGHT ST WITH ECHO 10X13 EL,C1781,HCPCS,278,RC,,,,both,11937.15,8356.01,,,,,,,,,,,,,,,,,,,Other,2573.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2573.65,2573.65, MESH VENTRALIGHT ST WITH ECHO 8X10 EL,C1781,HCPCS,278,RC,,,,both,5907.09,4134.96,,,,,,,,,,,,,,,,,,,Other,1273.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1273.57,1273.57, MESH VENTRALIGHT ST WITH ECHO 20CM CIRCL,C1781,HCPCS,278,RC,,,,both,8167.78,5717.45,,,,,,,,,,,,,,,,,,,Other,1760.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1760.97,1760.97, MESH VENTALIGHT PS 4.5,C1781,HCPCS,278,RC,,,,both,2158.74,1511.12,,,,,,,,,,,,,,,,,,,Other,465.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,465.42,465.42, MESH SURGICAL PARTIALLY ABSORBABLE PATCH,C1781,HCPCS,278,RC,,,,both,4758,3330.6,,,,,,,,,,,,,,,,,,,Other,1025.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1025.82,1025.82, MESH VENTRIO ST HERNIA PATCH 15.5CMX25.7,C1781,HCPCS,278,RC,,,,both,8711.51,6098.06,,,,,,,,,,,,,,,,,,,Other,1878.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1878.2,1878.2, MESH VENTRALIGHT ST WITH ECHO 6X8,C1781,HCPCS,278,RC,,,,both,3788.08,2651.66,,,,,,,,,,,,,,,,,,,Other,816.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,816.71,816.71, MESH VENTRIO ST HERNIA PATCH 3X3,C1781,HCPCS,278,RC,,,,both,2414.15,1689.91,,,,,,,,,,,,,,,,,,,Other,520.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,520.49,520.49, XEMPLIFI DBM GEL 5 CC,C1713,HCPCS,278,RC,,,,both,3413.25,2389.28,,,,,,,,,,,,,,,,,,,Other,735.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,735.9,735.9, PLATLET RICH PLASMA,278,RC,,,,,,both,2704.38,1893.07,,,,,,,,,,,,,,,,,,,Other,583.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,583.06,583.06, SET SCREW,C1713,HCPCS,278,RC,,,,both,183.15,128.21,,,,,,,,,,,,,,,,,,,Other,39.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.48,39.48, VOYAGER 7.5X45,278,RC,,,,,,both,4390.23,3073.16,,,,,,,,,,,,,,,,,,,Other,946.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,946.53,946.53, ELEVATE 28X7,278,RC,,,,,,both,16156.03,11309.22,,,,,,,,,,,,,,,,,,,Other,3483.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3483.24,3483.24, VOYAGER 6.5X45,278,RC,,,,,,both,4390.23,3073.16,,,,,,,,,,,,,,,,,,,Other,946.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,946.53,946.53, VOYAGER ROD 45MM,C1776,HCPCS,278,RC,,,,both,949.05,664.34,,,,,,,,,,,,,,,,,,,Other,204.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,204.61,204.61, NEEDLE TROCAR PAK,278,RC,,,,,,both,502.23,351.56,,,,,,,,,,,,,,,,,,,Other,108.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,108.28,108.28, NEEDLE BEVELED PAK,278,RC,,,,,,both,502.23,351.56,,,,,,,,,,,,,,,,,,,Other,108.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,108.28,108.28, BAYONEXES KNIFE,278,RC,,,,,,both,1372.38,960.67,,,,,,,,,,,,,,,,,,,Other,295.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,295.88,295.88, GUIDE WIRE,272,RC,,,,,,both,166.5,116.55,,,,,,,,,,,,,,,,,,,Other,35.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.9,35.9, ELEVATE 9X28MM,278,RC,,,,,,both,16156.03,11309.22,,,,,,,,,,,,,,,,,,,Other,3483.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3483.24,3483.24, 40MM ECLIF PLATE,278,RC,,,,,,both,3775.65,2642.96,,,,,,,,,,,,,,,,,,,Other,814.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,814.03,814.03, VOYAGER 7.5X50,278,RC,,,,,,both,4390.23,3073.16,,,,,,,,,,,,,,,,,,,Other,946.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,946.53,946.53, PERC ROD 30MM,278,RC,,,,,,both,2546.33,1782.43,,,,,,,,,,,,,,,,,,,Other,548.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,548.99,548.99, 4.0X14MM FIXED SCREW,278,RC,,,,,,both,1324.99,927.49,,,,,,,,,,,,,,,,,,,Other,285.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,285.67,285.67, 4.0X14MM VARIABLE SCREW,278,RC,,,,,,both,1324.99,927.49,,,,,,,,,,,,,,,,,,,Other,285.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,285.67,285.67, 10X14X11 CORNERSTONE PSR,278,RC,,,,,,both,3161.02,2212.71,,,,,,,,,,,,,,,,,,,Other,681.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,681.51,681.51, OPTEFORM 5CC,278,RC,,,,,,both,5812.67,4068.87,,,,,,,,,,,,,,,,,,,Other,1253.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1253.21,1253.21, OPTEFORM 10CC,278,RC,,,,,,both,9711.18,6797.83,,,,,,,,,,,,,,,,,,,Other,2093.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2093.73,2093.73, 6X14X11 CORNERSTONE PSR,C1889,HCPCS,278,RC,,,,both,3071.93,2150.35,,,,,,,,,,,,,,,,,,,Other,662.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,662.3,662.3, XEMPLIFI DBM PUTTY 10 CC,278,RC,,,,,,both,6146.41,4302.49,,,,,,,,,,,,,,,,,,,Other,1325.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1325.17,1325.17, RISE SPACER 8X22MM 7-13MM,278,RC,,,,,,both,20801.21,14560.85,,,,,,,,,,,,,,,,,,,Other,4484.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4484.74,4484.74, SHEATH INTRODUCER 6F,278,RC,,,,,,both,203.25,142.28,,,,,,,,,,,,,,,,,,,Other,43.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.83,43.83, CREO AMP 6.5X40MM MODULAR CANNULATED SCR,C1713,HCPCS,278,RC,,,,both,1498.5,1048.95,,,,,,,,,,,,,,,,,,,Other,323.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,323.08,323.08, CREO AMP 6.5X45MM MODULAR CANNULATED SCR,C1713,HCPCS,278,RC,,,,both,1498.5,1048.95,,,,,,,,,,,,,,,,,,,Other,323.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,323.08,323.08, CREO MIS LOCKING CAP,C1776,HCPCS,278,RC,,,,both,166.5,116.55,,,,,,,,,,,,,,,,,,,Other,35.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.9,35.9, CREO MIS MODULAR POLYAXIAL TULIP 10MM RE,C1713,HCPCS,278,RC,,,,both,1665,1165.5,,,,,,,,,,,,,,,,,,,Other,358.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,358.97,358.97, ANCHOR 5.5MM BONE,C1713,HCPCS,278,RC,,,,both,1348.21,943.75,,,,,,,,,,,,,,,,,,,Other,290.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,290.68,290.68, DRILL 4.5 MM,272,RC,,,,,,both,878.05,614.64,,,,,,,,,,,,,,,,,,,Other,189.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,189.31,189.31, DRILL 3.5 MM,272,RC,,,,,,both,878.05,614.64,,,,,,,,,,,,,,,,,,,Other,189.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,189.31,189.31, CREO MIS 5.5MM CURVED ROD TITANIUM ALLOY,C1713,HCPCS,278,RC,,,,both,749.25,524.48,,,,,,,,,,,,,,,,,,,Other,161.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,161.54,161.54, "CREO MIS 5.5MM CURVED ROD, TITANIUM ALLO",C1713,HCPCS,278,RC,,,,both,749.25,524.48,,,,,,,,,,,,,,,,,,,Other,161.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,161.54,161.54, 1.6MM K-WIRE 500MM BLUNT TIP,272,RC,,,,,,both,529.47,370.63,,,,,,,,,,,,,,,,,,,Other,114.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,114.15,114.15, "1.6MM NITINOL K-WIRE, 500MM, BLUNT TIP",L8699,HCPCS,272,RC,,,,both,511.99,358.39,,,,,,,,,,,,,,,,,,,Other,110.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,110.39,110.39, "RISE SPACER, 10X26MM, 8-15MM, 10DEGREE",278,RC,,,,,,both,20801.21,14560.85,,,,,,,,,,,,,,,,,,,Other,4484.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4484.74,4484.74, XEMPLIFI DBM GEL 1CC,C1713,HCPCS,278,RC,,,,both,853.31,597.32,,,,,,,,,,,,,,,,,,,Other,183.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,183.98,183.98, XTEND ANTERIOR CERVICAL PLATE 1-LEVEL 12,L8699,HCPCS,278,RC,,,,both,3413.25,2389.28,,,,,,,,,,,,,,,,,,,Other,735.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,735.9,735.9, SCREW LAG VHS W/COMP SCREW,C1713,HCPCS,278,RC,,,,both,1064.91,745.44,,,,,,,,,,,,,,,,,,,Other,229.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,229.59,229.59, "SCREW FEMORAL INTERF. 8MMX20MM,3.5MM",C1713,HCPCS,278,RC,,,,both,341.32,238.92,,,,,,,,,,,,,,,,,,,Other,73.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,73.59,73.59, "SCREW FEMORAL INTERF. 9MMX25MM,3.5MM",C1713,HCPCS,278,RC,,,,both,341.32,238.92,,,,,,,,,,,,,,,,,,,Other,73.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,73.59,73.59, "XTEND 4.2MM VARIABLE ANGLE SCREW, SELF-D",278,RC,,,,,,both,790.25,553.18,,,,,,,,,,,,,,,,,,,Other,170.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,170.38,170.38, XTEND ANTERIOR CERVICAL PLATE 2-LEVEL 26,L8699,HCPCS,278,RC,,,,both,3413.25,2389.28,,,,,,,,,,,,,,,,,,,Other,735.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,735.9,735.9, "XTEND 4.2MM VARIABLE ANGLE SCREW, SELF-D",278,RC,,,,,,both,790.25,553.18,,,,,,,,,,,,,,,,,,,Other,170.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,170.38,170.38, "XTEND 4.2MM VARIABLE ANGLE SCREW, SELF-D",278,RC,,,,,,both,790.25,553.18,,,,,,,,,,,,,,,,,,,Other,170.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,170.38,170.38, AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 14MM,C1713,HCPCS,278,RC,,,,both,1959.21,1371.45,,,,,,,,,,,,,,,,,,,Other,422.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,422.41,422.41, SCREW CANNULATED COMPRESSION S.S 12MM,C1713,HCPCS,278,RC,,,,both,1262.14,883.5,,,,,,,,,,,,,,,,,,,Other,272.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,272.12,272.12, K-WIRE SINGLE TROCAR POINT,C1713,HCPCS,278,RC,,,,both,179.82,125.87,,,,,,,,,,,,,,,,,,,Other,38.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,38.77,38.77, SCREW 2.7MM 13MM,C1713,HCPCS,278,RC,,,,both,221.98,155.39,,,,,,,,,,,,,,,,,,,Other,47.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.86,47.86, PLATE VARI-ANGLE 4 HOLE,C1713,HCPCS,278,RC,,,,both,1440.37,1008.26,,,,,,,,,,,,,,,,,,,Other,310.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,310.54,310.54, SCREW LAG W/COMP 12.7MM X 70MM,C1713,HCPCS,278,RC,,,,both,596,417.2,,,,,,,,,,,,,,,,,,,Other,128.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,128.5,128.5, SCREW CORTIAL SCREW 4.5SS,C1713,HCPCS,278,RC,,,,both,113.47,79.43,,,,,,,,,,,,,,,,,,,Other,24.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.46,24.46, TIBIAL INSERT SIZE 4 15MM,278,RC,,,,,,both,7270.21,5089.15,,,,,,,,,,,,,,,,,,,Other,1567.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1567.46,1567.46, "PIN THREADED TIP GD 2.5MM X 9""",C1713,HCPCS,278,RC,,,,both,174.14,121.9,,,,,,,,,,,,,,,,,,,Other,37.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.54,37.54, PLATE KEYLESS 4 HOLE,C1713,HCPCS,278,RC,,,,both,1621.27,1134.89,,,,,,,,,,,,,,,,,,,Other,349.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,349.55,349.55, SCREW LAG W/COMP,C1713,HCPCS,278,RC,,,,both,959.11,671.38,,,,,,,,,,,,,,,,,,,Other,206.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,206.78,206.78, SCREW CORTIAL SCREW 4.5SS,C1713,HCPCS,278,RC,,,,both,113.47,79.43,,,,,,,,,,,,,,,,,,,Other,24.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.46,24.46, SCREW CORTIAL SCREW 4.5SS,C1713,HCPCS,278,RC,,,,both,134.48,94.14,,,,,,,,,,,,,,,,,,,Other,29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,29,29, PLATE 4 HOLE 8 HOLE HEAD,C1713,HCPCS,278,RC,,,,both,2867.09,2006.96,,,,,,,,,,,,,,,,,,,Other,618.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,618.14,618.14, PLATE 5 HOLE,C1713,HCPCS,278,RC,,,,both,2952.42,2066.69,,,,,,,,,,,,,,,,,,,Other,636.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,636.54,636.54, PLATE 3 HOLE 3.5 LCP,C1713,HCPCS,278,RC,,,,both,5000.34,3500.24,,,,,,,,,,,,,,,,,,,Other,1078.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1078.07,1078.07, PLATE 6 HOLE VHS VARI-ANGLE,C1713,HCPCS,278,RC,,,,both,1621.27,1134.89,,,,,,,,,,,,,,,,,,,Other,349.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,349.55,349.55, PLATE 4 HOLE VHS VARI-ANGLE,C1713,HCPCS,278,RC,,,,both,1911.39,1337.97,,,,,,,,,,,,,,,,,,,Other,412.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,412.1,412.1, PLATE 7 HOLE 3.5 LCP,C1713,HCPCS,278,RC,,,,both,648.51,453.96,,,,,,,,,,,,,,,,,,,Other,139.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,139.82,139.82, PLATE 2 HOLE 56MM,C1713,HCPCS,278,RC,,,,both,1911.39,1337.97,,,,,,,,,,,,,,,,,,,Other,412.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,412.1,412.1, TIBIAL INSERT,278,RC,,,,,,both,7551.18,5285.83,,,,,,,,,,,,,,,,,,,Other,1628.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1628.03,1628.03, TIBIAL INSERT,278,RC,,,,,,both,4908.28,3435.8,,,,,,,,,,,,,,,,,,,Other,1058.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1058.22,1058.22, TIBIAL INSERT,278,RC,,,,,,both,7621.43,5335,,,,,,,,,,,,,,,,,,,Other,1643.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1643.18,1643.18, "PLATE STANDARD TUBE135MM DIA.,4 HOLE",278,RC,,,,,,both,1521.3,1064.91,,,,,,,,,,,,,,,,,,,Other,328,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,328,328, BONE SCREW 4.5X44MM SELF TAPPING,C1713,HCPCS,278,RC,,,,both,90.73,63.51,,,,,,,,,,,,,,,,,,,Other,19.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.56,19.56, BONE SCREW 4.5X46MM SELF TAPPING,278,RC,,,,,,both,90.73,63.51,,,,,,,,,,,,,,,,,,,Other,19.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.56,19.56, SCREW - 90MM,278,RC,,,,,,both,965.12,675.58,,,,,,,,,,,,,,,,,,,Other,208.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,208.08,208.08, "SCREW COMPRESSION 1""",278,RC,,,,,,both,206.18,144.33,,,,,,,,,,,,,,,,,,,Other,44.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.45,44.45, SCREW 2.2MM 14MM,C1713,HCPCS,278,RC,,,,both,432.28,302.6,,,,,,,,,,,,,,,,,,,Other,93.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,93.2,93.2, SCREW LOCKING 2.7MM 13MM,C1713,HCPCS,278,RC,,,,both,411.19,287.83,,,,,,,,,,,,,,,,,,,Other,88.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,88.65,88.65, SCREW LOCKING 2.7MM 15MM,C1713,HCPCS,278,RC,,,,both,411.19,287.83,,,,,,,,,,,,,,,,,,,Other,88.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,88.65,88.65, "3.5MM ULS ONE-THIRD TUBULAR PLT 8H, 107M",C1713,HCPCS,278,RC,,,,both,620.18,434.13,,,,,,,,,,,,,,,,,,,Other,133.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,133.71,133.71, "3.5MM ULS ONE-THIRD TUBULAR PLT 10H, 133",C1713,HCPCS,278,RC,,,,both,632.8,442.96,,,,,,,,,,,,,,,,,,,Other,136.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,136.44,136.44, PLATE 10MM 46MM RIB,278,RC,,,,,,both,3143.41,2200.39,,,,,,,,,,,,,,,,,,,Other,677.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,677.72,677.72, SCREW RIB 10MM,272,RC,,,,,,both,333.66,233.56,,,,,,,,,,,,,,,,,,,Other,71.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.94,71.94, DRILL BIT 2.2MM,272,RC,,,,,,both,312.79,218.95,,,,,,,,,,,,,,,,,,,Other,67.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,67.43,67.43, SCREW 2.4 LOCKING 2.7MM 18MM,C1713,HCPCS,278,RC,,,,both,369.96,258.97,,,,,,,,,,,,,,,,,,,Other,79.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,79.76,79.76, SCREW 2.4 LOCKING 2.7MM 16MM,C1713,HCPCS,278,RC,,,,both,399.6,279.72,,,,,,,,,,,,,,,,,,,Other,86.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,86.15,86.15, SCREW 2.4 LOCKING 2.7MM 12MM,C1713,HCPCS,278,RC,,,,both,399.6,279.72,,,,,,,,,,,,,,,,,,,Other,86.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,86.15,86.15, SCREW 2.7MM 16MM,C1713,HCPCS,278,RC,,,,both,221.98,155.39,,,,,,,,,,,,,,,,,,,Other,47.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.86,47.86, SCREW 2.7MM 14MM,C1713,HCPCS,278,RC,,,,both,221.98,155.39,,,,,,,,,,,,,,,,,,,Other,47.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.86,47.86, SCREW 2.7MM 12MM,C1713,HCPCS,278,RC,,,,both,221.98,155.39,,,,,,,,,,,,,,,,,,,Other,47.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.86,47.86, TOPAZ MICRO DEDRIDER,272,RC,,,,,,both,1274.92,892.44,,,,,,,,,,,,,,,,,,,Other,274.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,274.87,274.87, DVR CROSSLOCK PLATE LEFT,C1713,HCPCS,278,RC,,,,both,2977.02,2083.91,,,,,,,,,,,,,,,,,,,Other,641.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,641.84,641.84, LP NON LOCK 2.7MM X 10MM,C1713,HCPCS,278,RC,,,,both,217.6,152.32,,,,,,,,,,,,,,,,,,,Other,46.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,46.91,46.91, DVR CROSSLOCK PLATE RIGHT,C1713,HCPCS,278,RC,,,,both,2977.02,2083.91,,,,,,,,,,,,,,,,,,,Other,641.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,641.84,641.84, TIBIAL INSERT,278,RC,,,,,,both,7621.43,5335,,,,,,,,,,,,,,,,,,,Other,1643.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1643.18,1643.18, STEM FLUTED EXTENSION,278,RC,,,,,,both,4225.68,2957.98,,,,,,,,,,,,,,,,,,,Other,911.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,911.06,911.06, TIBIAL AUG. BLK,278,RC,,,,,,both,5566.81,3896.77,,,,,,,,,,,,,,,,,,,Other,1200.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1200.21,1200.21, TIBIAL INSERT CR SLOPE,278,RC,,,,,,both,5275.83,3693.08,,,,,,,,,,,,,,,,,,,Other,1137.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1137.47,1137.47, TIBIAL INSERT CR SLOPE,278,RC,,,,,,both,7919.98,5543.99,,,,,,,,,,,,,,,,,,,Other,1707.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1707.55,1707.55, ACETABULAR CUP,278,RC,,,,,,both,20503.5,14352.45,,,,,,,,,,,,,,,,,,,Other,4420.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4420.55,4420.55, SUMMIT STEW SIZE 2 HI-OFF SET,278,RC,,,,,,both,21776.36,15243.45,,,,,,,,,,,,,,,,,,,Other,4694.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4694.98,4694.98, SLEEVE ADAPTOR T2,272,RC,,,,,,both,1422.44,995.71,,,,,,,,,,,,,,,,,,,Other,306.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,306.68,306.68, STEM EXTENSION,278,RC,,,,,,both,6251.68,4376.18,,,,,,,,,,,,,,,,,,,Other,1347.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1347.86,1347.86, DRILL BIT QUICK RELEASE,272,RC,,,,,,both,730.54,511.38,,,,,,,,,,,,,,,,,,,Other,157.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,157.51,157.51, TIBIAL INSERT CR SLOPE,278,RC,,,,,,both,4869.99,3408.99,,,,,,,,,,,,,,,,,,,Other,1049.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1049.97,1049.97, LP NON LOCK 2.7MMX 18MM,C1713,HCPCS,278,RC,,,,both,221.98,155.39,,,,,,,,,,,,,,,,,,,Other,47.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.86,47.86, SCREW LOCKING 2.7MM 14MM,C1713,HCPCS,278,RC,,,,both,366.63,256.64,,,,,,,,,,,,,,,,,,,Other,79.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,79.05,79.05, DVR LOCK NARROW MINI L,C1713,HCPCS,278,RC,,,,both,2754.54,1928.18,,,,,,,,,,,,,,,,,,,Other,593.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,593.88,593.88, LOCK SCREW SQUARE 2.7MMX14MM,C1713,HCPCS,278,RC,,,,both,432.28,302.6,,,,,,,,,,,,,,,,,,,Other,93.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,93.2,93.2, FEMORAL UNI INPLANT,278,RC,,,,,,both,8014.94,5610.46,,,,,,,,,,,,,,,,,,,Other,1728.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1728.02,1728.02, DVR LOCK NARROW L,C1713,HCPCS,278,RC,,,,both,3664.23,2564.96,,,,,,,,,,,,,,,,,,,Other,790.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,790.01,790.01, SCREW LOCKING 2.7MM 8MM,C1713,HCPCS,278,RC,,,,both,432.28,302.6,,,,,,,,,,,,,,,,,,,Other,93.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,93.2,93.2, GUIDE WIRE .91MMX80MM SS,C1769,HCPCS,278,RC,,,,both,197.52,138.26,,,,,,,,,,,,,,,,,,,Other,42.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.58,42.58, CREO AMP 6.5X35MM MODULAR CANNULATED SCR,C1713,HCPCS,278,RC,,,,both,2047.95,1433.57,,,,,,,,,,,,,,,,,,,Other,441.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,441.54,441.54, ADAPTOR TAPER SLEEVE,278,RC,,,,,,both,1422.44,995.71,,,,,,,,,,,,,,,,,,,Other,306.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,306.68,306.68, PUTTY 1CC,278,RC,,,,,,both,709.47,496.63,,,,,,,,,,,,,,,,,,,Other,152.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,152.96,152.96, 15MM 4.0 VARIABLE SCREW/MEDTRONIC,C1713,HCPCS,278,RC,,,,both,1287.65,901.36,,,,,,,,,,,,,,,,,,,Other,277.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,277.61,277.61, PLATE 35MM 21LV ATLANTIS,278,RC,,,,,,both,3775.65,2642.96,,,,,,,,,,,,,,,,,,,Other,814.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,814.03,814.03, DNO TICRON 2 BLUE 30 T-56/HGS-21,272,RC,,,,,,both,34.91,24.44,,,,,,,,,,,,,,,,,,,Other,7.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.53,7.53, HIP STEM TAPERED W/POROCOAT,278,RC,,,,,,both,21776.36,15243.45,,,,,,,,,,,,,,,,,,,Other,4694.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4694.98,4694.98, CREO MIS 5.5X50mm CURVED ROD TITANIUM AL,C1713,HCPCS,278,RC,,,,both,749.25,524.48,,,,,,,,,,,,,,,,,,,Other,161.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,161.54,161.54, 5X14X11 CORNERSTONE PSR,C1713,HCPCS,278,RC,,,,both,2630.7,1841.49,,,,,,,,,,,,,,,,,,,Other,567.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,567.18,567.18, PLATE 19MM,C1713,HCPCS,278,RC,,,,both,3424.43,2397.1,,,,,,,,,,,,,,,,,,,Other,738.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,738.3,738.3, 4X15MM SCREW,C1713,HCPCS,278,RC,,,,both,1324.99,927.49,,,,,,,,,,,,,,,,,,,Other,285.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,285.67,285.67, TISSUE SPINAL GRAFT,C1762,HCPCS,278,RC,,,,both,709.47,496.63,,,,,,,,,,,,,,,,,,,Other,152.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,152.96,152.96, "RISE SPACER, 10X26MM, 7-14MM",C1889,HCPCS,278,RC,,,,both,20214.98,14150.49,,,,,,,,,,,,,,,,,,,Other,4358.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4358.35,4358.35, RISE SPACER 10X30MM 8-15MM 10 DEGREE,C1889,HCPCS,278,RC,,,,both,20214.98,14150.49,,,,,,,,,,,,,,,,,,,Other,4358.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4358.35,4358.35, OVERTUBEGUARDUS 8.6-10.0 25CM,272,RC,,,,,,both,668.18,467.73,,,,,,,,,,,,,,,,,,,Other,144.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,144.06,144.06, GRAFTON 3CC,C1713,HCPCS,278,RC,,,,both,2477.52,1734.26,,,,,,,,,,,,,,,,,,,Other,534.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,534.15,534.15, TIP SUCTION ORTHO,272,RC,,,,,,both,103.78,72.65,,,,,,,,,,,,,,,,,,,Other,22.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.37,22.37, PERI SCREW 3.55X14MM,C1713,HCPCS,278,RC,,,,both,162.09,113.46,,,,,,,,,,,,,,,,,,,Other,34.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.95,34.95, 3.5 MM CANNULATED SCREW,C1713,HCPCS,278,RC,,,,both,663.52,464.46,,,,,,,,,,,,,,,,,,,Other,143.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,143.05,143.05, PERI SCREW 3.5X MM X 26 W/ 2.7 MM,C1713,HCPCS,278,RC,,,,both,162.09,113.46,,,,,,,,,,,,,,,,,,,Other,34.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.95,34.95, DISTAL LATERAL FIBULA LOCKING PLATE,C1713,HCPCS,278,RC,,,,both,2366.71,1656.7,,,,,,,,,,,,,,,,,,,Other,510.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,510.27,510.27, 2.7MM CORTICAL SCREW 16MM,C1713,HCPCS,278,RC,,,,both,97.33,68.13,,,,,,,,,,,,,,,,,,,Other,20.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.98,20.98, 2.7MM CORTICAL SCREW 18MM,C1713,HCPCS,278,RC,,,,both,97.33,68.13,,,,,,,,,,,,,,,,,,,Other,20.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.98,20.98, DISTAL LATERAL FIBULA LOCKING PLATE 4H 8,C1713,HCPCS,278,RC,,,,both,2308.99,1616.29,,,,,,,,,,,,,,,,,,,Other,497.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,497.82,497.82, SCREW FORTE CANCELLOUS 4.0MMX10MM FULL T,272,RC,,,,,,both,239.62,167.73,,,,,,,,,,,,,,,,,,,Other,51.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,51.67,51.67, SCREW 3.5 CORTEX 14MM,C1713,HCPCS,278,RC,,,,both,111.37,77.96,,,,,,,,,,,,,,,,,,,Other,24.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.01,24.01, SCREW 3.5 CORTEX 16MM,C1713,HCPCS,278,RC,,,,both,108.65,76.06,,,,,,,,,,,,,,,,,,,Other,23.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.42,23.42, SCREW 3.5 CORTEX 18MM,C1713,HCPCS,278,RC,,,,both,111.37,77.96,,,,,,,,,,,,,,,,,,,Other,24.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.01,24.01, SCREW EXT. STEM,C1713,HCPCS,278,RC,,,,both,238.1,166.67,,,,,,,,,,,,,,,,,,,Other,51.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,51.33,51.33, 2.7MM STANDARD DRILL,272,RC,,,,,,both,481.87,337.31,,,,,,,,,,,,,,,,,,,Other,103.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,103.89,103.89, TAO Q-C FOR 3.5MM SCREWS 110MM,C1713,HCPCS,278,RC,,,,both,321.04,224.73,,,,,,,,,,,,,,,,,,,Other,69.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,69.22,69.22, SCREW FORTE CANCELLOUS 4.0MMX14MM FULL T,C1713,HCPCS,278,RC,,,,both,227.19,159.03,,,,,,,,,,,,,,,,,,,Other,48.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,48.98,48.98, DISTAL LATERAL FIBULA LOCKING PLATE 6H 1,C1713,HCPCS,278,RC,,,,both,2469.52,1728.66,,,,,,,,,,,,,,,,,,,Other,532.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,532.42,532.42, CREO AMP 6.5X50MM MODULAR CANNULATED SCR,C1713,HCPCS,278,RC,,,,both,1498.5,1048.95,,,,,,,,,,,,,,,,,,,Other,323.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,323.08,323.08, SCREW FORTE CANCELLOUS 4.0MMX16MM FULL T,C1713,HCPCS,278,RC,,,,both,227.19,159.03,,,,,,,,,,,,,,,,,,,Other,48.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,48.98,48.98, TRAY TIBIAL TRAPEZOID,278,RC,,,,,,both,13030.19,9121.13,,,,,,,,,,,,,,,,,,,Other,2809.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2809.31,2809.31, TRAY TIBIAL TRAPEZOID,272,RC,,,,,,both,9033.51,6323.46,,,,,,,,,,,,,,,,,,,Other,1947.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1947.62,1947.62, TRAY TIBIAL TRAP,272,RC,,,,,,both,9033.51,6323.46,,,,,,,,,,,,,,,,,,,Other,1947.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1947.62,1947.62, TIBIAL INSERT,278,RC,,,,,,both,6919,4843.3,,,,,,,,,,,,,,,,,,,Other,1491.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1491.74,1491.74, TRAY TIBIAL TRAP,272,RC,,,,,,both,12187.27,8531.09,,,,,,,,,,,,,,,,,,,Other,2627.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2627.58,2627.58, TIBIAL INSERT CR SLOPE,278,RC,,,,,,both,7270.21,5089.15,,,,,,,,,,,,,,,,,,,Other,1567.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1567.46,1567.46, TRAY TIBIAL TRAPEZOID,278,RC,,,,,,both,13030.19,9121.13,,,,,,,,,,,,,,,,,,,Other,2809.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2809.31,2809.31, TRAY TIBIAL TRAPEZOID,272,RC,,,,,,both,13557.02,9489.91,,,,,,,,,,,,,,,,,,,Other,2922.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2922.89,2922.89, TIBIAL INSERT SIZE 4 15MM,278,RC,,,,,,both,8116.65,5681.66,,,,,,,,,,,,,,,,,,,Other,1749.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1749.95,1749.95, 4.0 MM CANNULATED SCREW 1/3 THD 48MM,C1713,HCPCS,278,RC,,,,both,708.58,496.01,,,,,,,,,,,,,,,,,,,Other,152.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,152.77,152.77, TIBIAL INSERT SIZE 4 9MM,278,RC,,,,,,both,4644.52,3251.16,,,,,,,,,,,,,,,,,,,Other,1001.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1001.35,1001.35, TIBIAL INSERT SIZE 3 11MM SLOPE,278,RC,,,,,,both,7270.21,5089.15,,,,,,,,,,,,,,,,,,,Other,1567.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1567.46,1567.46, TIBIAL INSERT SIZE 3 13MM SLOPE,278,RC,,,,,,both,7270.21,5089.15,,,,,,,,,,,,,,,,,,,Other,1567.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1567.46,1567.46, 4.0MM CANNULATED SCREW 1/3 THD 4MM,C1713,HCPCS,278,RC,,,,both,674.7,472.29,,,,,,,,,,,,,,,,,,,Other,145.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,145.46,145.46, 35MM ECLIF PLATE,C1889,HCPCS,278,RC,,,,both,3669.24,2568.47,,,,,,,,,,,,,,,,,,,Other,791.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,791.09,791.09, 4.0 X 15MM FIXED SCREW,C1713,HCPCS,278,RC,,,,both,1256.24,879.37,,,,,,,,,,,,,,,,,,,Other,270.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,270.84,270.84, CREO AMP 7.5X40MM CANNULATED SCREW,C1713,HCPCS,278,RC,,,,both,1998,1398.6,,,,,,,,,,,,,,,,,,,Other,430.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,430.77,430.77, CREO AMP 7.5X45MM CANNULATED SCREW,C1713,HCPCS,278,RC,,,,both,1498.5,1048.95,,,,,,,,,,,,,,,,,,,Other,323.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,323.08,323.08, CREO AMP 7.5x55mm MOD CANNULATED SCREW,C1713,HCPCS,278,RC,,,,both,1980,1386,,,,,,,,,,,,,,,,,,,Other,426.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,426.89,426.89, FEMORAL POROUS SIZE 4 LEFT,278,RC,,,,,,both,14425.76,10098.03,,,,,,,,,,,,,,,,,,,Other,3110.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3110.2,3110.2, FEMORAL HEAD 28MM +10,278,RC,,,,,,both,4326.13,3028.29,,,,,,,,,,,,,,,,,,,Other,932.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,932.72,932.72, FEMORAL POROUS,278,RC,,,,,,both,14074.19,9851.93,,,,,,,,,,,,,,,,,,,Other,3034.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3034.39,3034.39, "QCKFIX SCREW, TI, CANC, PT, 3.0X28MM",C1713,HCPCS,278,RC,,,,both,499.5,349.65,,,,,,,,,,,,,,,,,,,Other,107.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,107.69,107.69, "QCKFIX SCREW, TI, CANC, PT, 3.0X30MM",C1713,HCPCS,278,RC,,,,both,499.5,349.65,,,,,,,,,,,,,,,,,,,Other,107.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,107.69,107.69, "THD GDWIRE W TRCR TIP, .45"" W/LASER",A4649,HCPCS,272,RC,,,,both,86.49,60.54,,,,,,,,,,,,,,,,,,,Other,18.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.65,18.65, "COUNTERSINK, 3.0MM, CANNULATED",A4649,HCPCS,272,RC,,,,both,614.64,430.25,,,,,,,,,,,,,,,,,,,Other,132.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,132.52,132.52, FEMORAL POROUS,278,RC,,,,,,both,22302.18,15611.53,,,,,,,,,,,,,,,,,,,Other,4808.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4808.35,4808.35, PLATE 19MM ZEVO,C1713,HCPCS,278,RC,,,,both,3246.75,2272.73,,,,,,,,,,,,,,,,,,,Other,700,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,700,700, 3.15X15MM FIXED SCREW,C1713,HCPCS,278,RC,,,,both,399.6,279.72,,,,,,,,,,,,,,,,,,,Other,86.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,86.15,86.15, HEAD RESURFACING 50X19,278,RC,,,,,,both,23637.05,16545.94,,,,,,,,,,,,,,,,,,,Other,5096.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5096.15,5096.15, CLIP OTSC SYSTEM SET 12/6GC 165CM,272,RC,,,,,,both,2068.7,1448.09,,,,,,,,,,,,,,,,,,,Other,446.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,446.01,446.01, CLIP OTSC SYSTEM SET 12/6T 220CM,272,RC,,,,,,both,1945.78,1362.05,,,,,,,,,,,,,,,,,,,Other,419.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,419.51,419.51, CLIP OTSC SYSTEM SET 11/6T 165CM,272,RC,,,,,,both,1538.36,1076.85,,,,,,,,,,,,,,,,,,,Other,331.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,331.67,331.67, ANCHOR OTSC 165CM,278,RC,,,,,,both,1548.89,1084.22,,,,,,,,,,,,,,,,,,,Other,333.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,333.94,333.94, MESH VENTRALIGHT ST 30.5X35.6CM,C1781,HCPCS,278,RC,,,,both,9927.4,6949.18,,,,,,,,,,,,,,,,,,,Other,2140.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2140.35,2140.35, MESH VENTRALIGHT 4.5X11.4CM,C1781,HCPCS,278,RC,,,,both,1541.96,1079.37,,,,,,,,,,,,,,,,,,,Other,332.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,332.45,332.45, PLATE 35MM ZEVO,C1713,HCPCS,278,RC,,,,both,2497.5,1748.25,,,,,,,,,,,,,,,,,,,Other,538.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,538.46,538.46, 3.5 X 17MM FIXED SCREW,C1713,HCPCS,278,RC,,,,both,399.6,279.72,,,,,,,,,,,,,,,,,,,Other,86.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,86.15,86.15, FEMORAL HEAD,C1776,HCPCS,278,RC,,,,both,1356.96,949.87,,,,,,,,,,,,,,,,,,,Other,292.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,292.56,292.56, DNO PEDICLE ACCESSS KIT,C1713,HCPCS,278,RC,,,,both,1665,1165.5,,,,,,,,,,,,,,,,,,,Other,358.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,358.97,358.97, MESH OVAL 6X9IN,C1781,HCPCS,278,RC,,,,both,2059.04,1441.33,,,,,,,,,,,,,,,,,,,Other,443.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,443.93,443.93, CREO MIS 5.5MM CURVED ROD 75MM,C1713,HCPCS,278,RC,,,,both,1248.75,874.13,,,,,,,,,,,,,,,,,,,Other,269.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,269.24,269.24, SABLE SPACER 10 X 26 6-12MM 8 DEGREE,C1889,HCPCS,278,RC,,,,both,19980,13986,,,,,,,,,,,,,,,,,,,Other,4307.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4307.69,4307.69, ULTRAVERSE 130 3X40MM,C1725,HCPCS,278,RC,,,,both,749.25,524.48,,,,,,,,,,,,,,,,,,,Other,161.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,161.54,161.54, ULTRAVERSE 130CM 6X40MM,C1725,HCPCS,278,RC,,,,both,1202.13,841.49,,,,,,,,,,,,,,,,,,,Other,259.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,259.18,259.18, ULTRAVERSE 130 4X40MM,C1725,HCPCS,278,RC,,,,both,632.7,442.89,,,,,,,,,,,,,,,,,,,Other,136.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,136.41,136.41, PLATE 3-HOLE DVR,C1713,HCPCS,278,RC,,,,both,2653.97,1857.78,,,,,,,,,,,,,,,,,,,Other,572.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,572.19,572.19, CERVICAL CAGE CIF 6 DEG -07,L8699,HCPCS,278,RC,,,,both,9973.2,6981.24,,,,,,,,,,,,,,,,,,,Other,2150.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2150.22,2150.22, CERVICAL CAGE CIF 6 DEG -08,L8699,HCPCS,278,RC,,,,both,9973.2,6981.24,,,,,,,,,,,,,,,,,,,Other,2150.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2150.22,2150.22, CERVICAL PLATE 10MM,L8699,HCPCS,278,RC,,,,both,8533,5973.1,,,,,,,,,,,,,,,,,,,Other,1839.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1839.71,1839.71, CERVICAL PLATE 14 MM,L8699,HCPCS,278,RC,,,,both,8324.88,5827.42,,,,,,,,,,,,,,,,,,,Other,1794.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1794.84,1794.84, K-WIRE 1.6,C1713,HCPCS,278,RC,,,,both,136.65,95.66,,,,,,,,,,,,,,,,,,,Other,29.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,29.46,29.46, K-WIRE 0.8X100MM CANNULATED,C1769,HCPCS,278,RC,,,,both,539.45,377.62,,,,,,,,,,,,,,,,,,,Other,116.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,116.31,116.31, DRILL BIT 12MM,272,RC,,,,,,both,702.44,491.71,,,,,,,,,,,,,,,,,,,Other,151.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,151.45,151.45, SCREW SELF DRILLING 4.0X14MM,278,RC,,,,,,both,1404.87,983.41,,,,,,,,,,,,,,,,,,,Other,302.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,302.89,302.89, SCREW SELF DRILLING 4.0X12MM,278,RC,,,,,,both,1404.87,983.41,,,,,,,,,,,,,,,,,,,Other,302.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,302.89,302.89, DISTRACTION PIN 12MM,C1713,HCPCS,278,RC,,,,both,832.49,582.74,,,,,,,,,,,,,,,,,,,Other,179.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,179.49,179.49, CERVICAL PLATE,L8699,HCPCS,278,RC,,,,both,1535.94,1075.16,,,,,,,,,,,,,,,,,,,Other,331.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,331.15,331.15, "CERVICAL 3.5MM SELF DRILLING SCREW, 12MM",278,RC,,,,,,both,1141.46,799.02,,,,,,,,,,,,,,,,,,,Other,246.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,246.1,246.1, "CERVICAL 3.5MM SELF DRILLING SCREW, 14MM",278,RC,,,,,,both,1141.46,799.02,,,,,,,,,,,,,,,,,,,Other,246.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,246.1,246.1, SCREW MULTI DIRECTIONAL 24MM,C1713,HCPCS,278,RC,,,,both,492.83,344.98,,,,,,,,,,,,,,,,,,,Other,106.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,106.25,106.25, SCREW 2.5 LOCKING 24MM,C1713,HCPCS,278,RC,,,,both,266.4,186.48,,,,,,,,,,,,,,,,,,,Other,57.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,57.44,57.44, SCREW 3.5 LOCKING 12MM,C1713,HCPCS,278,RC,,,,both,266.4,186.48,,,,,,,,,,,,,,,,,,,Other,57.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,57.44,57.44, "CERVICAL 4.0MM SELF DRILLING SCREW, 12MM",278,RC,,,,,,both,1141.46,799.02,,,,,,,,,,,,,,,,,,,Other,246.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,246.1,246.1, "TESERA SC CAGE, 16MMX13.5MMX6MM, 7",L8699,HCPCS,278,RC,,,,both,16383.35,11468.35,,,,,,,,,,,,,,,,,,,Other,3532.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3532.25,3532.25, INSERTS MULTI 2.0,272,RC,,,,,,both,231.8,162.26,,,,,,,,,,,,,,,,,,,Other,49.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,49.98,49.98, "CERVICAL CAGE CIF, 6 DEG, -06",L8699,HCPCS,278,RC,,,,both,9973.2,6981.24,,,,,,,,,,,,,,,,,,,Other,2150.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2150.22,2150.22, "1-LEVEL, 12MM CERVICAL PLATE",L8699,HCPCS,278,RC,,,,both,8324.88,5827.42,,,,,,,,,,,,,,,,,,,Other,1794.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1794.84,1794.84, DISTRACTION PIN 14MM,C1713,HCPCS,278,RC,,,,both,853.3,597.31,,,,,,,,,,,,,,,,,,,Other,183.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,183.98,183.98, 7MM 4 HOLE ANTERIOR PLATE,C1713,HCPCS,278,RC,,,,both,8324.88,5827.42,,,,,,,,,,,,,,,,,,,Other,1794.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1794.84,1794.84, 7MM LOCKING COVER,C1713,HCPCS,278,RC,,,,both,832.49,582.74,,,,,,,,,,,,,,,,,,,Other,179.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,179.49,179.49, 3.5MM VARIABLE SCREW SELF DRILLING 14MM,C1713,HCPCS,278,RC,,,,both,1365.28,955.7,,,,,,,,,,,,,,,,,,,Other,294.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,294.35,294.35, "DRILL, 12MM",272,RC,,,,,,both,702.44,491.71,,,,,,,,,,,,,,,,,,,Other,151.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,151.45,151.45, "INTERBODY, 16X14X7MM 7 DEGREE STERILE",C1713,HCPCS,278,RC,,,,both,9973.2,6981.24,,,,,,,,,,,,,,,,,,,Other,2150.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2150.22,2150.22, MOBI-C CERVICAL DISC PROSTHESIS 15X 15,L8699,HCPCS,278,RC,,,,both,14851.8,10396.26,,,,,,,,,,,,,,,,,,,Other,3202.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3202.05,3202.05, CANNULATED DRILL Q-C,272,RC,,,,,,both,1901.56,1331.09,,,,,,,,,,,,,,,,,,,Other,409.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,409.97,409.97, PIN GUIDE 1.6MM X 9IN PARTIAL THREAD,278,RC,,,,,,both,288.01,201.61,,,,,,,,,,,,,,,,,,,Other,62.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,62.09,62.09, WASHER 3. AND 4.0 SCREW,278,RC,,,,,,both,159.83,111.88,,,,,,,,,,,,,,,,,,,Other,34.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.46,34.46, SCREW CANNULATED 4.0X60MM 1/2 THREAD,C1713,HCPCS,278,RC,,,,both,656.15,459.31,,,,,,,,,,,,,,,,,,,Other,141.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,141.46,141.46, CANNULATED DRILL Q-C 4.5MM,272,RC,,,,,,both,1707.19,1195.03,,,,,,,,,,,,,,,,,,,Other,368.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,368.07,368.07, 6.5MM CANNULATED SCREW 16MM THD 80MM,C1713,HCPCS,278,RC,,,,both,721.08,504.76,,,,,,,,,,,,,,,,,,,Other,155.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,155.47,155.47, 6.5MM CANNULATED SCREW 16MM THD 85MM,C1713,HCPCS,278,RC,,,,both,721.08,504.76,,,,,,,,,,,,,,,,,,,Other,155.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,155.47,155.47, 3.2MM X 9IN PARTIAL THD TROCAR TIP GDE P,272,RC,,,,,,both,325.75,228.03,,,,,,,,,,,,,,,,,,,Other,70.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,70.24,70.24, "1.6MM X 6IN SMOOTH TROCARTIP GDE PIN, 5/",272,RC,,,,,,both,208.48,145.94,,,,,,,,,,,,,,,,,,,Other,44.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.95,44.95, 6.5MM CANNULATED SCREW 16MM THD 70MM,C1713,HCPCS,278,RC,,,,both,805.18,563.63,,,,,,,,,,,,,,,,,,,Other,173.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,173.6,173.6, "CABLE CERCLAGE 1.8MMX22"" GRIP",278,RC,,,,,,both,1300.94,910.66,,,,,,,,,,,,,,,,,,,Other,280.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,280.49,280.49, CABLE CERCLAGE 1.8MMX635MM COCR,278,RC,,,,,,both,1308.86,916.2,,,,,,,,,,,,,,,,,,,Other,282.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,282.19,282.19, GTR 5 HOLE EXTENDED W/4 CABLES,278,RC,,,,,,both,14206.6,9944.62,,,,,,,,,,,,,,,,,,,Other,3062.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3062.94,3062.94, 6.5MM CANNULATED SCREW 16MM THD 75MM,C1713,HCPCS,278,RC,,,,both,805.18,563.63,,,,,,,,,,,,,,,,,,,Other,173.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,173.6,173.6, WIRE K 2.0X150MM,278,RC,,,,,,both,269.34,188.54,,,,,,,,,,,,,,,,,,,Other,58.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,58.06,58.06, SUTURE ORTHOCORD,272,RC,,,,,,both,103.04,72.13,,,,,,,,,,,,,,,,,,,Other,22.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.22,22.22, ANCHOR HEALIX 4.5MM,278,RC,,,,,,both,1197.65,838.36,,,,,,,,,,,,,,,,,,,Other,258.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,258.21,258.21, DISTRACTION PIN 14MM,C1713,HCPCS,278,RC,,,,both,239.86,167.9,,,,,,,,,,,,,,,,,,,Other,51.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,51.71,51.71, MOBI-C CERVICAL DISC PROSTHESIS 17X17,L8699,HCPCS,278,RC,,,,both,15282.5,10697.75,,,,,,,,,,,,,,,,,,,Other,3294.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3294.91,3294.91, CARBOJET TUBE,272,RC,,,,,,both,544.38,381.07,,,,,,,,,,,,,,,,,,,Other,117.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,117.36,117.36, BONE SCREW 4.5X40MM THREADED,278,RC,,,,,,both,90.73,63.51,,,,,,,,,,,,,,,,,,,Other,19.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.56,19.56, FEMORAL FIXATION 4 HOLE 135 DEGREE,278,RC,,,,,,both,1521.3,1064.91,,,,,,,,,,,,,,,,,,,Other,328,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,328,328, SCREW LAG 70MM 12.7 MM,C1713,HCPCS,278,RC,,,,both,965.12,675.58,,,,,,,,,,,,,,,,,,,Other,208.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,208.08,208.08, IMPACTOR HEAD,272,RC,,,,,,both,498.73,349.11,,,,,,,,,,,,,,,,,,,Other,107.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,107.53,107.53, BONE SCREW 4.5X42MM,278,RC,,,,,,both,90.73,63.51,,,,,,,,,,,,,,,,,,,Other,19.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.56,19.56, DVR LOCK NARROW R,C1713,HCPCS,278,RC,,,,both,3063.35,2144.35,,,,,,,,,,,,,,,,,,,Other,660.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,660.46,660.46, SCREW 2.7MM 15MM,C1713,HCPCS,278,RC,,,,both,219.78,153.85,,,,,,,,,,,,,,,,,,,Other,47.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.38,47.38, SHEATH 18FR,272,RC,,,,,,both,439.02,307.31,,,,,,,,,,,,,,,,,,,Other,94.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,94.65,94.65, SHEATH 12FR,272,RC,,,,,,both,277.47,194.23,,,,,,,,,,,,,,,,,,,Other,59.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,59.82,59.82, GRAFT,C1768,HCPCS,278,RC,,,,both,26880.79,18816.55,,,,,,,,,,,,,,,,,,,Other,5795.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5795.49,5795.49, GRAFT - LINE EXTENDER,C1768,HCPCS,278,RC,,,,both,10572.59,7400.81,,,,,,,,,,,,,,,,,,,Other,2279.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2279.45,2279.45, GRAFT 10 10,278,RC,,,,,,both,12643.86,8850.7,,,,,,,,,,,,,,,,,,,Other,2726.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2726.02,2726.02, FEMUR POROUS,278,RC,,,,,,both,22302.18,15611.53,,,,,,,,,,,,,,,,,,,Other,4808.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4808.35,4808.35, TRAY TIBIAL TRAP,272,RC,,,,,,both,13557.02,9489.91,,,,,,,,,,,,,,,,,,,Other,2922.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2922.89,2922.89, TIBIAL INSERT CR SLOPE,278,RC,,,,,,both,7919.98,5543.99,,,,,,,,,,,,,,,,,,,Other,1707.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1707.55,1707.55, PROXIMAL TIBIAL SPACER,278,RC,,,,,,both,5759.98,4031.99,,,,,,,,,,,,,,,,,,,Other,1241.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1241.86,1241.86, CREO MIS 5.5MM 80MM CURVED ROD TITANIUM,C1713,HCPCS,278,RC,,,,both,1248.75,874.13,,,,,,,,,,,,,,,,,,,Other,269.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,269.24,269.24, SCREW 4.0MM - 40 MM LENGTH,278,RC,,,,,,both,491.7,344.19,,,,,,,,,,,,,,,,,,,Other,106.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,106.01,106.01, SCREW 4.0MM - 44 MM LENGTH,278,RC,,,,,,both,491.7,344.19,,,,,,,,,,,,,,,,,,,Other,106.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,106.01,106.01, SCREW 4.0MM - 48 MM LENGTH,278,RC,,,,,,both,491.7,344.19,,,,,,,,,,,,,,,,,,,Other,106.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,106.01,106.01, SCREW 4.0MM - 50 MM LENGTH,278,RC,,,,,,both,491.7,344.19,,,,,,,,,,,,,,,,,,,Other,106.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,106.01,106.01, BONE SCREW 6.5x35,C1713,HCPCS,278,RC,,,,both,233.1,163.17,,,,,,,,,,,,,,,,,,,Other,50.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.25,50.25, K-WIRE .35X6 DBL TRO 6PK NS,272,RC,,,,,,both,301.52,211.06,,,,,,,,,,,,,,,,,,,Other,65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,65,65, K-WIRE .045X6 DBL TRO 6PK NS,272,RC,,,,,,both,301.52,211.06,,,,,,,,,,,,,,,,,,,Other,65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,65,65, Z NAIL 5.0X30 CORT SCREW FA,C1713,HCPCS,278,RC,,,,both,691.46,484.02,,,,,,,,,,,,,,,,,,,Other,149.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,149.08,149.08, CONTINUUM MULTI-HOLE SHELL 64 OO,C1776,HCPCS,278,RC,,,,both,8909.61,6236.73,,,,,,,,,,,,,,,,,,,Other,1920.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1920.91,1920.91, CONTINUUM MULTI-HOLE SHELL 62NN,C1776,HCPCS,278,RC,,,,both,7326,5128.2,,,,,,,,,,,,,,,,,,,Other,1579.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1579.49,1579.49, SCREW LOCKING CAP NCB,C1713,HCPCS,278,RC,,,,both,476.69,333.68,,,,,,,,,,,,,,,,,,,Other,102.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,102.77,102.77, SCREW 5.0 CANCELLOUS 65MM,278,RC,,,,,,both,667.32,467.12,,,,,,,,,,,,,,,,,,,Other,143.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,143.87,143.87, NCB CANCEL SCREW 5.0 32 L80,278,RC,,,,,,both,667.32,467.12,,,,,,,,,,,,,,,,,,,Other,143.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,143.87,143.87, SCREW 5.0 CANCELLOUS 85MM,278,RC,,,,,,both,667.32,467.12,,,,,,,,,,,,,,,,,,,Other,143.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,143.87,143.87, "SCREW NCB 5.0,L. 34MM",278,RC,,,,,,both,790.24,553.17,,,,,,,,,,,,,,,,,,,Other,170.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,170.37,170.37, Z NAIL 5.0X32.5 CORT SCREW,C1713,HCPCS,278,RC,,,,both,708.75,496.13,,,,,,,,,,,,,,,,,,,Other,152.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,152.81,152.81, "NCB DRILL BIT 4.3MM,L. 195MM",272,RC,,,,,,both,540.87,378.61,,,,,,,,,,,,,,,,,,,Other,116.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,116.61,116.61, Z NAIL 5.0X27.5 CORT SCREW,C1713,HCPCS,278,RC,,,,both,620.81,434.57,,,,,,,,,,,,,,,,,,,Other,133.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,133.85,133.85, CALIBRATED DRILL 4.3MM LONG,271,RC,,,,,,both,343.66,240.56,,,,,,,,,,,,,,,,,,,Other,74.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,74.1,74.1, "CONTINUUM LONGEVITY NEUTRAL LINER, II 32",C1776,HCPCS,278,RC,,,,both,3172.31,2220.62,,,,,,,,,,,,,,,,,,,Other,683.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,683.95,683.95, PLATE TIBIA NCB PROXIMAL,C1713,HCPCS,278,RC,,,,both,2708.44,1895.91,,,,,,,,,,,,,,,,,,,Other,583.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,583.94,583.94, PERI SCREW 3.5MMX10MM W2.7MM HEAD,C1713,HCPCS,278,RC,,,,both,158.14,110.7,,,,,,,,,,,,,,,,,,,Other,34.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.09,34.09, PERI SCREW 3.5MM X 12MM W/2.7 HEAD,C1713,HCPCS,278,RC,,,,both,158.14,110.7,,,,,,,,,,,,,,,,,,,Other,34.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.09,34.09, PERI SCREW 3.5MM X 12MM W/2.7 HEAD,C1713,HCPCS,278,RC,,,,both,158.14,110.7,,,,,,,,,,,,,,,,,,,Other,34.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.09,34.09, PERI SCREW 3.5MM X 24MM W/2.7 HEAD,C1713,HCPCS,278,RC,,,,both,158.14,110.7,,,,,,,,,,,,,,,,,,,Other,34.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.09,34.09, BONE SCREW 6.5 X 30MM,278,RC,,,,,,both,513.66,359.56,,,,,,,,,,,,,,,,,,,Other,110.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,110.75,110.75, PERI SCREW 3.5MM X 40MM W/2.7 HEAD,C1713,HCPCS,278,RC,,,,both,158.14,110.7,,,,,,,,,,,,,,,,,,,Other,34.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.09,34.09, LOCKING SCREW 3.5MM X 20MM W/2.7 HEAD,C1713,HCPCS,278,RC,,,,both,358.1,250.67,,,,,,,,,,,,,,,,,,,Other,77.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,77.2,77.2, "FEMORAL STEM SZ 11, 145MM",278,RC,,,,,,both,20290.28,14203.2,,,,,,,,,,,,,,,,,,,Other,4374.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4374.58,4374.58, BONE SCREW,C1713,HCPCS,278,RC,,,,both,233.1,163.17,,,,,,,,,,,,,,,,,,,Other,50.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.25,50.25, NCB QC 3.3MM X 195MM,272,RC,,,,,,both,597.07,417.95,,,,,,,,,,,,,,,,,,,Other,128.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,128.73,128.73, 2.5MM QC 180MM BIT,272,RC,,,,,,both,288.24,201.77,,,,,,,,,,,,,,,,,,,Other,62.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,62.14,62.14, "FEMORAL STEM SZ 14, 160MM",278,RC,,,,,,both,18263.34,12784.34,,,,,,,,,,,,,,,,,,,Other,3937.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3937.57,3937.57, FEMORAL HEAD 36MM O.D.,278,RC,,,,,,both,4280.48,2996.34,,,,,,,,,,,,,,,,,,,Other,922.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,922.88,922.88, "CROWN CUP 2, 36MM I.D.",278,RC,,,,,,both,6311.39,4417.97,,,,,,,,,,,,,,,,,,,Other,1360.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1360.74,1360.74, DRILL BIT 20MM 4.5 NOVATION,278,RC,,,,,,both,242.34,169.64,,,,,,,,,,,,,,,,,,,Other,52.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,52.24,52.24, BONE SCREW 6.5 X 20,C1713,HCPCS,278,RC,,,,both,236.46,165.52,,,,,,,,,,,,,,,,,,,Other,50.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.98,50.98, CUP CLUSTER-HOLE SHELL,278,RC,,,,,,both,7759.64,5431.75,,,,,,,,,,,,,,,,,,,Other,1672.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1672.98,1672.98, CUP CROWN CLUSTER-HOLE,278,RC,,,,,,both,7551.27,5285.89,,,,,,,,,,,,,,,,,,,Other,1628.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1628.05,1628.05, DISTAL VOTAR RADIAL LOCKING PLATE,278,RC,,,,,,both,2913.4,2039.38,,,,,,,,,,,,,,,,,,,Other,628.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,628.13,628.13, PERIARTICULAR LOCKING PEG,278,RC,,,,,,both,227.52,159.26,,,,,,,,,,,,,,,,,,,Other,49.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,49.05,49.05, PERIARTICULAR LOCKING SCREW 2.4MMX20MM,278,RC,,,,,,both,377.93,264.55,,,,,,,,,,,,,,,,,,,Other,81.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.48,81.48, PERIARTICULAR LOCKING SCREW 2.4MMX22MM,278,RC,,,,,,both,377.93,264.55,,,,,,,,,,,,,,,,,,,Other,81.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.48,81.48, PERIARTICULAR LOCKING SCREW 2.4MMX14MM,278,RC,,,,,,both,300.86,210.6,,,,,,,,,,,,,,,,,,,Other,64.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,64.87,64.87, BIT 1.8MM,272,RC,,,,,,both,1049.1,734.37,,,,,,,,,,,,,,,,,,,Other,226.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,226.18,226.18, K-WIRES 1.6MMX150MM,278,RC,,,,,,both,277.42,194.19,,,,,,,,,,,,,,,,,,,Other,59.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,59.81,59.81, DISTAL VOTAR RADIAL LOCKING PLATE,278,RC,,,,,,both,3052.85,2137,,,,,,,,,,,,,,,,,,,Other,658.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,658.2,658.2, PERIARTICULAR LOCKING SCREW 2.4MMX18MM,278,RC,,,,,,both,377.93,264.55,,,,,,,,,,,,,,,,,,,Other,81.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.48,81.48, PERIARTICULAR LOCKING SCREW 2.4MMX16MM,278,RC,,,,,,both,300.86,210.6,,,,,,,,,,,,,,,,,,,Other,64.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,64.87,64.87, SCREW CORTICAL 2.7X22MM,C1713,HCPCS,278,RC,,,,both,89.38,62.57,,,,,,,,,,,,,,,,,,,Other,19.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.27,19.27, SCREW CORTICAL 2.7X14MM,C1713,HCPCS,278,RC,,,,both,87.2,61.04,,,,,,,,,,,,,,,,,,,Other,18.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.8,18.8, DISTAL VOTAR RADIAL LOCKING PLATE,278,RC,,,,,,both,2913.4,2039.38,,,,,,,,,,,,,,,,,,,Other,628.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,628.13,628.13, K-WIRES TROCAR POINT 1.25MM X 150MM,278,RC,,,,,,both,277.42,194.19,,,,,,,,,,,,,,,,,,,Other,59.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,59.81,59.81, ELEMENT STEM,278,RC,,,,,,both,18729.48,13110.64,,,,,,,,,,,,,,,,,,,Other,4038.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4038.08,4038.08, DRILL BIT Q-C 2.5MM DIA 110MM,272,RC,,,,,,both,267.09,186.96,,,,,,,,,,,,,,,,,,,Other,57.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,57.58,57.58, FEMORAL HEAD 36MM O.D.,278,RC,,,,,,both,6505.08,4553.56,,,,,,,,,,,,,,,,,,,Other,1402.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1402.5,1402.5, PERIARTICULAR LOCKING SCREW 2.4MMX12MM,278,RC,,,,,,both,300.86,210.6,,,,,,,,,,,,,,,,,,,Other,64.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,64.87,64.87, PERIARTICULAR LOCKING SCREW 2.4MMX18MM,278,RC,,,,,,both,300.86,210.6,,,,,,,,,,,,,,,,,,,Other,64.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,64.87,64.87, PERIARTICULAR LOCKING SCREW 2.4MMX22MM,278,RC,,,,,,both,300.86,210.6,,,,,,,,,,,,,,,,,,,Other,64.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,64.87,64.87, PERIARTICULAR CORTICAL SCREW 16MMX3.5MM,C1713,HCPCS,278,RC,,,,both,162.88,114.02,,,,,,,,,,,,,,,,,,,Other,35.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.11,35.11, LOCKING SCREW 2.7X18MM,278,RC,,,,,,both,373.47,261.43,,,,,,,,,,,,,,,,,,,Other,80.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,80.52,80.52, 2.0 STANDARD DRILL QC 175MM LONG,272,RC,,,,,,both,2682.81,1877.97,,,,,,,,,,,,,,,,,,,Other,578.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,578.42,578.42, 2.0 STANDARD DRILL QC 100MM LONG,272,RC,,,,,,both,241.89,169.32,,,,,,,,,,,,,,,,,,,Other,52.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,52.16,52.16, 2.5 STANDARD DRILL QC 110MM LONG,272,RC,,,,,,both,241.89,169.32,,,,,,,,,,,,,,,,,,,Other,52.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,52.16,52.16, K-WIRE 2X150MM SMOOTH TROCAR POINT,272,RC,,,,,,both,277.42,194.19,,,,,,,,,,,,,,,,,,,Other,59.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,59.81,59.81, PLATE PERIARTICULAR DISTAL LATERAL FIBUL,272,RC,,,,,,both,2543.62,1780.53,,,,,,,,,,,,,,,,,,,Other,548.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,548.41,548.41, SCREW FORTE CANCELLOUS 4.0MMX18MM,272,RC,,,,,,both,234.03,163.82,,,,,,,,,,,,,,,,,,,Other,50.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.46,50.46, SCREW FORTE CANCELLOUS 4.0MMX20MM,272,RC,,,,,,both,209.92,146.94,,,,,,,,,,,,,,,,,,,Other,45.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,45.26,45.26, SCREW FORTE CANCELLOUS 4.0MMX22MM,272,RC,,,,,,both,209.92,146.94,,,,,,,,,,,,,,,,,,,Other,45.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,45.26,45.26, GUIDE WIRE 1.6,C1769,HCPCS,278,RC,,,,both,152.03,106.42,,,,,,,,,,,,,,,,,,,Other,32.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.78,32.78, DRILL BIT 30MM 4.5,278,RC,,,,,,both,249.61,174.73,,,,,,,,,,,,,,,,,,,Other,53.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,53.81,53.81, "CONTINUUM LONGEVITY NEUTRAL LINER, JJ 32",C1776,HCPCS,278,RC,,,,both,3267.48,2287.24,,,,,,,,,,,,,,,,,,,Other,704.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,704.47,704.47, CONTINUUM MULTI-HOLE SHELL,C1776,HCPCS,278,RC,,,,both,7545.78,5282.05,,,,,,,,,,,,,,,,,,,Other,1626.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1626.87,1626.87, "CONTINUUM LONGEVITY NEUTRAL LINER, HH 32",C1776,HCPCS,278,RC,,,,both,3267.48,2287.24,,,,,,,,,,,,,,,,,,,Other,704.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,704.47,704.47, PERI SCREW 3.5MM X 24MM W/2.7MM HEAD SEL,278,RC,,,,,,both,162.62,113.83,,,,,,,,,,,,,,,,,,,Other,35.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.06,35.06, ELEMENT STEM,278,RC,,,,,,both,20290.28,14203.2,,,,,,,,,,,,,,,,,,,Other,4374.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4374.58,4374.58, FEMORAL HEAD BIOLOX,278,RC,,,,,,both,8547.55,5983.29,,,,,,,,,,,,,,,,,,,Other,1842.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1842.85,1842.85, CROWN CUP NOVATION,278,RC,,,,,,both,7551.27,5285.89,,,,,,,,,,,,,,,,,,,Other,1628.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1628.05,1628.05, CROWN CUP NOVATION LINER,278,RC,,,,,,both,7042.45,4929.72,,,,,,,,,,,,,,,,,,,Other,1518.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1518.35,1518.35, CANNULATED DRILL TRINKLE END,272,RC,,,,,,both,1758.14,1230.7,,,,,,,,,,,,,,,,,,,Other,379.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,379.05,379.05, GUIDE PIN 2.4MMX9IN PARTIAL THREAD TRO,272,RC,,,,,,both,448.76,314.13,,,,,,,,,,,,,,,,,,,Other,96.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,96.76,96.76, WASHER FOR 4.5MM SCREW,272,RC,,,,,,both,164.62,115.23,,,,,,,,,,,,,,,,,,,Other,35.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.5,35.5, CANNULATED SCREW 4.5MMX70MM 1/3 THREAD,272,RC,,,,,,both,725.61,507.93,,,,,,,,,,,,,,,,,,,Other,156.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,156.44,156.44, GUIDE PIN 1.6MM X 9IN PARTIAL THREAD TIP,272,RC,,,,,,both,426.86,298.8,,,,,,,,,,,,,,,,,,,Other,92.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,92.03,92.03, WASHER FOR 5.5 THRU 7.5 SCREWS,272,RC,,,,,,both,164.62,115.23,,,,,,,,,,,,,,,,,,,Other,35.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.5,35.5, GUIDE PIN 3.2MM X 12IN PARTIAL THRD TIP,272,RC,,,,,,both,448.56,313.99,,,,,,,,,,,,,,,,,,,Other,96.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,96.71,96.71, FEMORAL COMPONENT SIZE E,C1776,HCPCS,278,RC,,,,both,14336.77,10035.74,,,,,,,,,,,,,,,,,,,Other,3091.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3091.01,3091.01, SCREW CANNULATED 4.0MMX46MM 1/2 THREAD,278,RC,,,,,,both,675.83,473.08,,,,,,,,,,,,,,,,,,,Other,145.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,145.71,145.71, CONTINUUM MULTI-HOLE SHELL 56 KK,C1776,HCPCS,278,RC,,,,both,7545.78,5282.05,,,,,,,,,,,,,,,,,,,Other,1626.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1626.87,1626.87, SCREW CANNULATED 6.5MMX80MMX16MM THREAD,C1713,HCPCS,278,RC,,,,both,818.12,572.68,,,,,,,,,,,,,,,,,,,Other,176.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,176.39,176.39, SCREW CANNULATED 6.5MMX85MMX16MM THREAD,278,RC,,,,,,both,818.12,572.68,,,,,,,,,,,,,,,,,,,Other,176.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,176.39,176.39, SCREW CANNULATED 6.5MMX100MMX16MM THREAD,278,RC,,,,,,both,818.12,572.68,,,,,,,,,,,,,,,,,,,Other,176.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,176.39,176.39, FEMORAL COMPONENT SIZE G,C1776,HCPCS,278,RC,,,,both,6954.63,4868.24,,,,,,,,,,,,,,,,,,,Other,1499.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1499.42,1499.42, LEGACY KNEE POSTERIOR STABILIZED SIZE G,C1776,HCPCS,278,RC,,,,both,3098.86,2169.2,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, STEMMED TIBIAL COMPONENT PRECOAT SIZE 7,C1776,HCPCS,278,RC,,,,both,3349.93,2344.95,,,,,,,,,,,,,,,,,,,Other,722.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,722.24,722.24, "LPS-FLEX GSF OPTION FEMORAL, SIZE C-LT",C1776,HCPCS,278,RC,,,,both,6954.63,4868.24,,,,,,,,,,,,,,,,,,,Other,1499.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1499.42,1499.42, Z NAIL 10.5X110 LAG SCREW,C1713,HCPCS,278,RC,,,,both,2033.6,1423.52,,,,,,,,,,,,,,,,,,,Other,438.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,438.44,438.44, "CONTINUUM LONGEVITY NEUTRAL LINER, KK 32",C1776,HCPCS,278,RC,,,,both,3172.31,2220.62,,,,,,,,,,,,,,,,,,,Other,683.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,683.95,683.95, LEGACY KNEE POSTERIOR STABILIZED SIZE EF,C1776,HCPCS,278,RC,,,,both,4072.94,2851.06,,,,,,,,,,,,,,,,,,,Other,878.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,878.13,878.13, SCREW CANNULATED 4.5 40MM,C1713,HCPCS,278,RC,,,,both,685.97,480.18,,,,,,,,,,,,,,,,,,,Other,147.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,147.89,147.89, SCREW CANNULATED 4.5 52MM,C1713,HCPCS,278,RC,,,,both,878.04,614.63,,,,,,,,,,,,,,,,,,,Other,189.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,189.31,189.31, WASHER 10 MM,278,RC,,,,,,both,126.94,88.86,,,,,,,,,,,,,,,,,,,Other,27.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,27.37,27.37, SCREW CANNULATED 7.3MM 100MM,C1713,HCPCS,278,RC,,,,both,878.04,614.63,,,,,,,,,,,,,,,,,,,Other,189.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,189.31,189.31, SCREW CANNULATED 7.3MM 115MM,C1713,HCPCS,278,RC,,,,both,899.99,629.99,,,,,,,,,,,,,,,,,,,Other,194.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,194.04,194.04, SCREW CANNULATED7.3 95MM,C1713,HCPCS,278,RC,,,,both,878.04,614.63,,,,,,,,,,,,,,,,,,,Other,189.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,189.31,189.31, SCREW CANNULATED 4.5 52MM,C1713,HCPCS,278,RC,,,,both,798.04,558.63,,,,,,,,,,,,,,,,,,,Other,172.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,172.06,172.06, FEMORAL COMPONENT SIZE E-LT,C1776,HCPCS,278,RC,,,,both,6954.63,4868.24,,,,,,,,,,,,,,,,,,,Other,1499.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1499.42,1499.42, ALL-POLY PATELLA 38MM,C1776,HCPCS,278,RC,,,,both,1978.48,1384.94,,,,,,,,,,,,,,,,,,,Other,426.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,426.56,426.56, PATELLA REAMER BLADE SIZE 46,272,RC,,,,,,both,509.35,356.55,,,,,,,,,,,,,,,,,,,Other,109.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,109.82,109.82, FEMORAL COMPONENT SIZE D LEFT,C1776,HCPCS,278,RC,,,,both,11935.56,8354.89,,,,,,,,,,,,,,,,,,,Other,2573.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2573.3,2573.3, FEMORAL HEAD 32MM-3.5,C1776,HCPCS,278,RC,,,,both,2117.93,1482.55,,,,,,,,,,,,,,,,,,,Other,456.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,456.62,456.62, VERSYS FM MC CLR 15X160MM STD NECK,C1776,HCPCS,278,RC,,,,both,12381.75,8667.23,,,,,,,,,,,,,,,,,,,Other,2669.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2669.51,2669.51, PERIARTICULAR LOCKING SCREW 2.4MMX14MM,C1713,HCPCS,278,RC,,,,both,381.53,267.07,,,,,,,,,,,,,,,,,,,Other,82.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,82.26,82.26, PERI LOCKING SCREW 3.5MMX16MM,C1713,HCPCS,278,RC,,,,both,381.53,267.07,,,,,,,,,,,,,,,,,,,Other,82.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,82.26,82.26, SCREW CANNULATED 3.5MMX50MM 1/2 THREAD,C1713,HCPCS,278,RC,,,,both,666.76,466.73,,,,,,,,,,,,,,,,,,,Other,143.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,143.76,143.76, GUIDE PIN 1.6MM X 6IN PARTIAL THREAD TIP,272,RC,,,,,,both,317.95,222.57,,,,,,,,,,,,,,,,,,,Other,68.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.55,68.55, DRILL BIT Q-C 3.5MM DIA 110MM,272,RC,,,,,,both,267.09,186.96,,,,,,,,,,,,,,,,,,,Other,57.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,57.58,57.58, FEMORAL HEAD 32MM+0,C1776,HCPCS,278,RC,,,,both,1397.66,978.36,,,,,,,,,,,,,,,,,,,Other,301.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,301.34,301.34, VERSYS 6 INCH BEADED FC 14X160MM STD NEC,C1776,HCPCS,278,RC,,,,both,8554.65,5988.26,,,,,,,,,,,,,,,,,,,Other,1844.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1844.38,1844.38, "CONTINUUM LONGEVITY NEUTRAL LINER, NN 32",C1776,HCPCS,278,RC,,,,both,3267.48,2287.24,,,,,,,,,,,,,,,,,,,Other,704.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,704.47,704.47, VERSYS 6 INCH BEADED FC 15X160MM STD BOD,C1776,HCPCS,278,RC,,,,both,8554.65,5988.26,,,,,,,,,,,,,,,,,,,Other,1844.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1844.38,1844.38, "CONTINUUM LONGEVITY NEUTRAL LINER, OO 32",C1776,HCPCS,278,RC,,,,both,3267.48,2287.24,,,,,,,,,,,,,,,,,,,Other,704.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,704.47,704.47, NEXGEN LPS-FLEX FIXED PROLONG ART SUR EF,C1776,HCPCS,278,RC,,,,both,3098.86,2169.2,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, CONTINUUM LONGEVITY NEUTRAL LINER II 36X,C1776,HCPCS,278,RC,,,,both,2664,1864.8,,,,,,,,,,,,,,,,,,,Other,574.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,574.36,574.36, CONTINUUM CLUSTER-HOLE SHELL 52 II,C1776,HCPCS,278,RC,,,,both,5440.8,3808.56,,,,,,,,,,,,,,,,,,,Other,1173.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1173.04,1173.04, Z NAIL 5.0X100 LAG SREW,C1713,HCPCS,278,RC,,,,both,1984,1388.8,,,,,,,,,,,,,,,,,,,Other,427.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,427.75,427.75, PASSER TWO PIN,272,RC,,,,,,both,797.68,558.38,,,,,,,,,,,,,,,,,,,Other,171.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,171.98,171.98, CONTINUUM MULTI-HOLE SHELL 52 II,C1776,HCPCS,278,RC,,,,both,7545.78,5282.05,,,,,,,,,,,,,,,,,,,Other,1626.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1626.87,1626.87, NEXGEN LPS-FLEX OPTION FEMORAL SIZE G-LT,C1776,HCPCS,278,RC,,,,both,6954.63,4868.24,,,,,,,,,,,,,,,,,,,Other,1499.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1499.42,1499.42, MODULAR HEAD 32MM+3MM NECK,C1776,HCPCS,278,RC,,,,both,1397.66,978.36,,,,,,,,,,,,,,,,,,,Other,301.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,301.34,301.34, Z NAIL 10.5X105 LAG SCREW,C1713,HCPCS,278,RC,,,,both,1729.34,1210.54,,,,,,,,,,,,,,,,,,,Other,372.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,372.84,372.84, Z NAIL CPM 11.5MMX21.5CM 130R,278,RC,,,,,,both,5468.77,3828.14,,,,,,,,,,,,,,,,,,,Other,1179.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1179.07,1179.07, CONTINUUM VIVACIT-E NEUTRAL LINER LL 32X,C1776,HCPCS,278,RC,,,,both,3267.48,2287.24,,,,,,,,,,,,,,,,,,,Other,704.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,704.47,704.47, GDE PIN 3.2MM X 12IN PARTIAL THD TROCAR,272,RC,,,,,,both,277.12,193.98,,,,,,,,,,,,,,,,,,,Other,59.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,59.75,59.75, CONTINUUM CLUSTER-HOLE SHELL 50 HH,C1776,HCPCS,278,RC,,,,both,7326,5128.2,,,,,,,,,,,,,,,,,,,Other,1579.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1579.49,1579.49, SCREW FORTE CANCELLOUS 4.0MMX22MM FULL T,272,RC,,,,,,both,246.81,172.77,,,,,,,,,,,,,,,,,,,Other,53.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,53.21,53.21, ACL KIT CAYENNE,272,RC,,,,,,both,1808.76,1266.13,,,,,,,,,,,,,,,,,,,Other,389.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,389.97,389.97, SCREW 9 MM X 25MM,278,RC,,,,,,both,1428.93,1000.25,,,,,,,,,,,,,,,,,,,Other,308.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,308.07,308.07, SCREW 8 MM X 25MM,278,RC,,,,,,both,1428.93,1000.25,,,,,,,,,,,,,,,,,,,Other,308.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,308.07,308.07, BLADE CONMED,272,RC,,,,,,both,288.68,202.08,,,,,,,,,,,,,,,,,,,Other,62.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,62.24,62.24, KNIFE ACL GRAFT DEPUY,272,RC,,,,,,both,562.16,393.51,,,,,,,,,,,,,,,,,,,Other,121.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,121.21,121.21, SCREW 8 MM X 25MM,278,RC,,,,,,both,1428.93,1000.25,,,,,,,,,,,,,,,,,,,Other,308.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,308.07,308.07, NEXGEN LPS-FLEX FIXED PROLONG ART SUR EF,C1776,HCPCS,278,RC,,,,both,3098.86,2169.2,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, PERI SCREW 3.5MM X 20MM W/2.7MM HEAD SEL,C1713,HCPCS,278,RC,,,,both,162.88,114.02,,,,,,,,,,,,,,,,,,,Other,35.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.11,35.11, 6.5MM CANNULATED SCREW 16MM THD 100MM,272,RC,,,,,,both,721.08,504.76,,,,,,,,,,,,,,,,,,,Other,155.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,155.47,155.47, CONTINUUM MULTI-HOLE SHELL 48 GG,C1776,HCPCS,278,RC,,,,both,7545.78,5282.05,,,,,,,,,,,,,,,,,,,Other,1626.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1626.87,1626.87, SCREW SPEED,278,RC,,,,,,both,1266.14,886.3,,,,,,,,,,,,,,,,,,,Other,272.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,272.98,272.98, PATELLA REAMER BLADE SIZE 51,272,RC,,,,,,both,509.35,356.55,,,,,,,,,,,,,,,,,,,Other,109.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,109.82,109.82, 6.5MM CANNULATED SCREW 16MM THD 105MM,C1713,HCPCS,278,RC,,,,both,827.29,579.1,,,,,,,,,,,,,,,,,,,Other,178.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,178.36,178.36, 6.5MM CANNULATED SCREW 16MM THD 110MM,C1713,HCPCS,278,RC,,,,both,827.29,579.1,,,,,,,,,,,,,,,,,,,Other,178.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,178.36,178.36, WIRE MAGNUM,278,RC,,,,,,both,111.35,77.95,,,,,,,,,,,,,,,,,,,Other,24.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.01,24.01, DISTAL LATERAL FIBULA RADIAL LOCKING 10H,278,RC,,,,,,both,3085.24,2159.67,,,,,,,,,,,,,,,,,,,Other,665.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,665.18,665.18, PIN GUIDE 1.6MM X 6IN PARTIAL THREAD,278,RC,,,,,,both,335.36,234.75,,,,,,,,,,,,,,,,,,,Other,72.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,72.3,72.3, 4.0MM CANNULATED SCREW 1/3 THD 46MM,C1713,HCPCS,278,RC,,,,both,708.75,496.13,,,,,,,,,,,,,,,,,,,Other,152.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,152.81,152.81, DRILL HAND FREE 4.3MM 152.5MM,272,RC,,,,,,both,299.33,209.53,,,,,,,,,,,,,,,,,,,Other,64.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,64.53,64.53, Z NAIL 5.0X40 CORT SCREW FA,C1713,HCPCS,278,RC,,,,both,712.2,498.54,,,,,,,,,,,,,,,,,,,Other,153.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,153.55,153.55, Z NAIL 5.0X42.5 CORT SCREW,C1713,HCPCS,278,RC,,,,both,730.01,511.01,,,,,,,,,,,,,,,,,,,Other,157.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,157.39,157.39, Z NAIL CPM 11.5MMX36CM,C1713,HCPCS,278,RC,,,,both,8215.88,5751.12,,,,,,,,,,,,,,,,,,,Other,1771.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1771.34,1771.34, DRILL HAND FREE 3.3MM,272,RC,,,,,,both,684.13,478.89,,,,,,,,,,,,,,,,,,,Other,147.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,147.5,147.5, DRILL CALIB HUM AFFIXUS,272,RC,,,,,,both,1823.28,1276.3,,,,,,,,,,,,,,,,,,,Other,393.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,393.1,393.1, AFFIXUS HUM BALL NOSE GW ST,C1713,HCPCS,272,RC,,,,both,1440.56,1008.39,,,,,,,,,,,,,,,,,,,Other,310.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,310.58,310.58, WIRE AIRSCH W/TROCAR 2.5MM,C1769,HCPCS,272,RC,,,,both,177.37,124.16,,,,,,,,,,,,,,,,,,,Other,38.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,38.24,38.24, SCREW BLUNT TIP AFFIXUS 4X56MM,C1713,HCPCS,272,RC,,,,both,768.3,537.81,,,,,,,,,,,,,,,,,,,Other,165.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,165.65,165.65, SCREW BONE ANN CORT 4X30MM,C1713,HCPCS,272,RC,,,,both,744.29,521,,,,,,,,,,,,,,,,,,,Other,160.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,160.47,160.47, NAIL PROXIMAL HUMERUS RT LONG AFFIXUS 8.,C1713,HCPCS,272,RC,,,,both,7490.9,5243.63,,,,,,,,,,,,,,,,,,,Other,1615.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1615.04,1615.04, CEMEX GENTA,278,RC,,,,,,both,1953.47,1367.43,,,,,,,,,,,,,,,,,,,Other,421.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,421.16,421.16, PASTE BONE 10 CC,278,RC,,,,,,both,7596.84,5317.79,,,,,,,,,,,,,,,,,,,Other,1637.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1637.87,1637.87, PASTE BONE OPTECURE,278,RC,,,,,,both,4775.16,3342.61,,,,,,,,,,,,,,,,,,,Other,1029.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1029.53,1029.53, 5CC BEAT-BSM KIT,C1713,HCPCS,278,RC,,,,both,4888.17,3421.72,,,,,,,,,,,,,,,,,,,Other,1053.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1053.89,1053.89, CONTINUUM VIVACIT-E NEUTRAL LINER LL 36M,C1776,HCPCS,278,RC,,,,both,3086.91,2160.84,,,,,,,,,,,,,,,,,,,Other,665.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,665.54,665.54, "FEMORAL STEM SZ 16, 170MM",278,RC,,,,,,both,20290.28,14203.2,,,,,,,,,,,,,,,,,,,Other,4374.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4374.58,4374.58, MODULAR HEAD 36MM +3MM NECK,C1776,HCPCS,278,RC,,,,both,2772.9,1941.03,,,,,,,,,,,,,,,,,,,Other,597.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,597.84,597.84, Z NAIL 10.5X85 LAG SCREW,C1713,HCPCS,278,RC,,,,both,1984.03,1388.82,,,,,,,,,,,,,,,,,,,Other,427.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,427.76,427.76, LOFT PFJ SIZE 3,278,RC,,,,,,both,20692.36,14484.65,,,,,,,,,,,,,,,,,,,Other,4461.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4461.27,4461.27, BIPOLAR LINER 42/43 OD X 22MM ID,C1776,HCPCS,278,RC,,,,both,685.98,480.19,,,,,,,,,,,,,,,,,,,Other,147.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,147.9,147.9, 6.5MM CANNULATED SCREW 16MM THD 95MM,C1713,HCPCS,278,RC,,,,both,721.08,504.76,,,,,,,,,,,,,,,,,,,Other,155.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,155.47,155.47, 6.5MM CANNULATED SCREW 16MM THD 115MM,C1713,HCPCS,278,RC,,,,both,827.3,579.11,,,,,,,,,,,,,,,,,,,Other,178.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,178.37,178.37, BIPOLAR SHEL 43MM OD,C1776,HCPCS,278,RC,,,,both,994.67,696.27,,,,,,,,,,,,,,,,,,,Other,214.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,214.45,214.45, ARCOS 1PC 9.5X175MM BRCH BODY STD,C1776,HCPCS,278,RC,,,,both,7117.04,4981.93,,,,,,,,,,,,,,,,,,,Other,1534.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1534.44,1534.44, 22.2MM DIA COCR MOD HD - 5 NK,C1776,HCPCS,278,RC,,,,both,1457.71,1020.4,,,,,,,,,,,,,,,,,,,Other,314.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,314.29,314.29, PACEMAKER LV GENERATOR,C1785,HCPCS,275,RC,,,,both,15434.31,10804.02,,,,,,,,,,,,,,,,,,,Other,3327.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3327.64,3327.64, PACEMAKER DUAL CHAMBER WITHOUT LEADS,C1785,HCPCS,275,RC,,,,both,18864.16,13204.91,,,,,,,,,,,,,,,,,,,Other,4067.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4067.12,4067.12, PACEMAKER DUAL CHAMBER,C1785,HCPCS,275,RC,,,,both,14062.38,9843.67,,,,,,,,,,,,,,,,,,,Other,3031.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3031.85,3031.85, FEMORAL HEAD,278,RC,,,,,,both,4319.36,3023.55,,,,,,,,,,,,,,,,,,,Other,931.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,931.25,931.25, PETELLA POLY 41 MM,278,RC,,,,,,both,2086.75,1460.73,,,,,,,,,,,,,,,,,,,Other,449.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,449.91,449.91, PEG PETELLA 23 MM,278,RC,,,,,,both,3023.92,2116.74,,,,,,,,,,,,,,,,,,,Other,651.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,651.95,651.95, CONGRUENT TIBIAL INSERT,278,RC,,,,,,both,5267.15,3687.01,,,,,,,,,,,,,,,,,,,Other,1135.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1135.59,1135.59, BASEPLATE CCM STEM TIBIAL SIZE 3 RIGHT,278,RC,,,,,,both,9029.4,6320.58,,,,,,,,,,,,,,,,,,,Other,1946.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1946.74,1946.74, FEMORAL COMPONENT SIZE 4 RIGHT,278,RC,,,,,,both,15045.37,10531.76,,,,,,,,,,,,,,,,,,,Other,3243.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3243.78,3243.78, BLADE LINVATEC/HALL 60X13X1.27,272,RC,,,,,,both,397.93,278.55,,,,,,,,,,,,,,,,,,,Other,85.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,85.79,85.79, FEMORAL COMPONENT RLP POROUS SIZE 4,278,RC,,,,,,both,13395.77,9377.04,,,,,,,,,,,,,,,,,,,Other,2888.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2888.13,2888.13, FEMORAL COMPONENT RLP POROUS SIZE 5,278,RC,,,,,,both,14560.64,10192.45,,,,,,,,,,,,,,,,,,,Other,3139.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3139.27,3139.27, BASEPLATE CCM STEM TIBIAL SIZE 4 RIGHT,278,RC,,,,,,both,8038.19,5626.73,,,,,,,,,,,,,,,,,,,Other,1733.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1733.03,1733.03, CONGRUENT TRIBIAL INSERT 3/4 10MM RT,278,RC,,,,,,both,4091.44,2864.01,,,,,,,,,,,,,,,,,,,Other,882.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,882.12,882.12, FEMORAL COMPONENT RLP POROUS SIZE 3,278,RC,,,,,,both,13395.77,9377.04,,,,,,,,,,,,,,,,,,,Other,2888.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2888.13,2888.13, FEMORAL COMPONENT POROUS SIZE 3 LEFT,278,RC,,,,,,both,15045.37,10531.76,,,,,,,,,,,,,,,,,,,Other,3243.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3243.78,3243.78, CONGRUENT TRIBIAL INSERT,278,RC,,,,,,both,5267.15,3687.01,,,,,,,,,,,,,,,,,,,Other,1135.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1135.59,1135.59, FEMORAL COMPONENT SIZE 3,278,RC,,,,,,both,14560.64,10192.45,,,,,,,,,,,,,,,,,,,Other,3139.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3139.27,3139.27, CONGRUENT TRIBIAL INSERT,278,RC,,,,,,both,4594.29,3216,,,,,,,,,,,,,,,,,,,Other,990.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,990.53,990.53, BASEPLATE CCM STEM TIBIAL SIZE 2 RIGHT,278,RC,,,,,,both,9206.66,6444.66,,,,,,,,,,,,,,,,,,,Other,1984.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1984.96,1984.96, BASEPLATE CCM STEM TIBIAL SIZE 1 RIGHT,278,RC,,,,,,both,8038.19,5626.73,,,,,,,,,,,,,,,,,,,Other,1733.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1733.03,1733.03, BASEPLATE CCM TIBIAL 2 LEFT,278,RC,,,,,,both,8038.19,5626.73,,,,,,,,,,,,,,,,,,,Other,1733.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1733.03,1733.03, BASEPLATE CCM STEM TIBIAL SIZE 5 LEFT,278,RC,,,,,,both,8038.19,5626.73,,,,,,,,,,,,,,,,,,,Other,1733.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1733.03,1733.03, BASEPLATE CCM TIBIAL 4 LEFT,278,RC,,,,,,both,8038.19,5626.73,,,,,,,,,,,,,,,,,,,Other,1733.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1733.03,1733.03, STEM P SERIES,278,RC,,,,,,both,22247.91,15573.54,,,,,,,,,,,,,,,,,,,Other,4796.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4796.65,4796.65, FEMORAL HEAD,278,RC,,,,,,both,4114.96,2880.47,,,,,,,,,,,,,,,,,,,Other,887.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,887.18,887.18, BIPOLAR,278,RC,,,,,,both,6059.4,4241.58,,,,,,,,,,,,,,,,,,,Other,1306.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1306.41,1306.41, CONGRUENT TRIBIAL INSERT 1/2 14MM RT,278,RC,,,,,,both,4594.29,3216,,,,,,,,,,,,,,,,,,,Other,990.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,990.53,990.53, FEMORAL HEAD,278,RC,,,,,,both,5607.2,3925.04,,,,,,,,,,,,,,,,,,,Other,1208.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1208.91,1208.91, FEMORAL COMPONENT RLP POROUS SIZE 2 RT,278,RC,,,,,,both,15045.37,10531.76,,,,,,,,,,,,,,,,,,,Other,3243.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3243.78,3243.78, BIPOLAR COMPONENT 28X55,278,RC,,,,,,both,5050.82,3535.57,,,,,,,,,,,,,,,,,,,Other,1088.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1088.96,1088.96, BIPOLAR,278,RC,,,,,,both,6692.47,4684.73,,,,,,,,,,,,,,,,,,,Other,1442.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1442.89,1442.89, BIPOLAR,278,RC,,,,,,both,5050.82,3535.57,,,,,,,,,,,,,,,,,,,Other,1088.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1088.96,1088.96, BIPOLAR,278,RC,,,,,,both,7054.21,4937.95,,,,,,,,,,,,,,,,,,,Other,1520.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1520.89,1520.89, KIT APPLICATOR,272,RC,,,,,,both,759.69,531.78,,,,,,,,,,,,,,,,,,,Other,163.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,163.79,163.79, CONGRUENT TRIBIAL INSERT 3/4 10MM LT,278,RC,,,,,,both,4091.44,2864.01,,,,,,,,,,,,,,,,,,,Other,882.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,882.12,882.12, BIPOLAR,278,RC,,,,,,both,7596.84,5317.79,,,,,,,,,,,,,,,,,,,Other,1637.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1637.87,1637.87, BIPOLAR,278,RC,,,,,,both,7054.21,4937.95,,,,,,,,,,,,,,,,,,,Other,1520.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1520.89,1520.89, STEM P SERIES,278,RC,,,,,,both,28216.87,19751.81,,,,,,,,,,,,,,,,,,,Other,6083.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6083.56,6083.56, STEM P SERIES,278,RC,,,,,,both,28216.87,19751.81,,,,,,,,,,,,,,,,,,,Other,6083.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6083.56,6083.56, FEMORAL HEAD,278,RC,,,,,,both,4455.91,3119.14,,,,,,,,,,,,,,,,,,,Other,960.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,960.69,960.69, BIPOLAR,278,RC,,,,,,both,5050.82,3535.57,,,,,,,,,,,,,,,,,,,Other,1088.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1088.96,1088.96, BIPOLAR COMPONENT,278,RC,,,,,,both,5050.82,3535.57,,,,,,,,,,,,,,,,,,,Other,1088.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1088.96,1088.96, FEMORAL COMPONENT RLP POROUS COCR 6,278,RC,,,,,,both,18362.68,12853.88,,,,,,,,,,,,,,,,,,,Other,3958.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3958.99,3958.99, BASEPLATE CCM STEM TIBIAL SIZE 6 LEFT,278,RC,,,,,,both,9029.4,6320.58,,,,,,,,,,,,,,,,,,,Other,1946.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1946.74,1946.74, CONGRUENT TRIBIAL INSERT 5/16 10MM LEFT,278,RC,,,,,,both,4594.29,3216,,,,,,,,,,,,,,,,,,,Other,990.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,990.53,990.53, BASEPLATE CCM STEM TIBIAL SIZE 6 RIGHT,278,RC,,,,,,both,9029.4,6320.58,,,,,,,,,,,,,,,,,,,Other,1946.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1946.74,1946.74, FEMORAL COMPONENT RLP POROUS SIZE 6 RT,278,RC,,,,,,both,18362.68,12853.88,,,,,,,,,,,,,,,,,,,Other,3958.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3958.99,3958.99, ELEMENT STEM,278,RC,,,,,,both,20290.28,14203.2,,,,,,,,,,,,,,,,,,,Other,4374.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4374.58,4374.58, TIBIAL INSERT CR SLOPE,278,RC,,,,,,both,5302.42,3711.69,,,,,,,,,,,,,,,,,,,Other,1143.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1143.2,1143.2, FEMUR POROUS SIZE 4,278,RC,,,,,,both,13395.77,9377.04,,,,,,,,,,,,,,,,,,,Other,2888.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2888.13,2888.13, STEM P SERIES,278,RC,,,,,,both,27493.36,19245.35,,,,,,,,,,,,,,,,,,,Other,5927.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5927.57,5927.57, STEM P SERIES,278,RC,,,,,,both,26046.34,18232.44,,,,,,,,,,,,,,,,,,,Other,5615.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5615.59,5615.59, STEM P SERIES,278,RC,,,,,,both,26046.34,18232.44,,,,,,,,,,,,,,,,,,,Other,5615.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5615.59,5615.59, STEM P SERIES,278,RC,,,,,,both,28216.87,19751.81,,,,,,,,,,,,,,,,,,,Other,6083.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6083.56,6083.56, STEM P SERIES,278,RC,,,,,,both,27493.36,19245.35,,,,,,,,,,,,,,,,,,,Other,5927.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5927.57,5927.57, ELEMENT STEM,278,RC,,,,,,both,28940.37,20258.26,,,,,,,,,,,,,,,,,,,Other,6239.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6239.54,6239.54, FEMORAL POROUS,278,RC,,,,,,both,21433.96,15003.77,,,,,,,,,,,,,,,,,,,Other,4621.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4621.16,4621.16, TRAY TIBIAL TRAP,278,RC,,,,,,both,13421.1,9394.77,,,,,,,,,,,,,,,,,,,Other,2893.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2893.59,2893.59, TIBIAL INSERT,278,RC,,,,,,both,7488.32,5241.82,,,,,,,,,,,,,,,,,,,Other,1614.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1614.48,1614.48, NEXGEN LPS 5-6 12 MM,C1776,HCPCS,278,RC,,,,both,3098.87,2169.21,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, NEXGEN LPS FEMORAL SIZE E RT,C1776,HCPCS,278,RC,,,,both,6954.63,4868.24,,,,,,,,,,,,,,,,,,,Other,1499.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1499.42,1499.42, NEXGEN LPS FEMORAL SIZE F RT,C1776,HCPCS,278,RC,,,,both,6954.63,4868.24,,,,,,,,,,,,,,,,,,,Other,1499.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1499.42,1499.42, NEXGEN LPS FLEX FEMORAL SIZE F LT,C1776,HCPCS,278,RC,,,,both,6954.63,4868.24,,,,,,,,,,,,,,,,,,,Other,1499.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1499.42,1499.42, NEXGEN LPS 5-6 17 MM,C1776,HCPCS,278,RC,,,,both,3024.47,2117.13,,,,,,,,,,,,,,,,,,,Other,652.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,652.07,652.07, DURAT DEG INS,278,RC,,,,,,both,5151.39,3605.97,,,,,,,,,,,,,,,,,,,Other,1110.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1110.64,1110.64, BONE SCREW 6.5 X 25 SELF TAP,C1713,HCPCS,278,RC,,,,both,243.55,170.49,,,,,,,,,,,,,,,,,,,Other,52.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,52.51,52.51, M/L TAPER KINECTIV STEM SIZE 15,C1776,HCPCS,278,RC,,,,both,6711.18,4697.83,,,,,,,,,,,,,,,,,,,Other,1446.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1446.93,1446.93, PSN FEM PS CMT CCR STD SZ7 L,C1776,HCPCS,278,RC,,,,both,6954.74,4868.32,,,,,,,,,,,,,,,,,,,Other,1499.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1499.44,1499.44, PSN TIB STM 5 DEG SIZE F L,C1776,HCPCS,278,RC,,,,both,3098.92,2169.24,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, ARCOS 16X175MM BRCH BODY STD,C1776,HCPCS,278,RC,,,,both,11318.67,7923.07,,,,,,,,,,,,,,,,,,,Other,2440.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2440.31,2440.31, PSN TIB STM 5 DEG SIZE F R,C1776,HCPCS,278,RC,,,,both,3086.91,2160.84,,,,,,,,,,,,,,,,,,,Other,665.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,665.54,665.54, BASEPLATE CCM STEM TIBIAL SIZE 4 LEFT,278,RC,,,,,,both,8038.19,5626.73,,,,,,,,,,,,,,,,,,,Other,1733.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1733.03,1733.03, BASEPLATE CCM STEM TIBIAL SIZE 5 RIGHT,278,RC,,,,,,both,8038.19,5626.73,,,,,,,,,,,,,,,,,,,Other,1733.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1733.03,1733.03, FEMORAL POROUS SIZE 3 LEFT,278,RC,,,,,,both,14858.53,10400.97,,,,,,,,,,,,,,,,,,,Other,3203.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3203.5,3203.5, PERI SCREW 3.5MM X 22MM W/2.7MM HEAD SEL,C1713,HCPCS,278,RC,,,,both,162.88,114.02,,,,,,,,,,,,,,,,,,,Other,35.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.11,35.11, SCREW FORTE CANCELLOUS 4.0MMX20MM FULL T,C1713,HCPCS,278,RC,,,,both,234.03,163.82,,,,,,,,,,,,,,,,,,,Other,50.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.46,50.46, LOCKING SCREW 3.5 x 14MM,C1713,HCPCS,278,RC,,,,both,1496.46,1047.52,,,,,,,,,,,,,,,,,,,Other,322.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,322.64,322.64, LOCKING SCREW 3.5 X 16MM,C1713,HCPCS,278,RC,,,,both,1496.46,1047.52,,,,,,,,,,,,,,,,,,,Other,322.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,322.64,322.64, LOCKING SCREW 3.5MM X 20MM,C1713,HCPCS,278,RC,,,,both,1496.46,1047.52,,,,,,,,,,,,,,,,,,,Other,322.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,322.64,322.64, LOCKING SCREW 3.5 X 22MM,C1713,HCPCS,278,RC,,,,both,1496.46,1047.52,,,,,,,,,,,,,,,,,,,Other,322.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,322.64,322.64, TEMP FIXATION PIN 1.1MM SMALL,C1713,HCPCS,278,RC,,,,both,504.2,352.94,,,,,,,,,,,,,,,,,,,Other,108.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,108.7,108.7, DRILL BIT 2.5 X 60MM,C1713,HCPCS,278,RC,,,,both,1200.46,840.32,,,,,,,,,,,,,,,,,,,Other,258.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,258.82,258.82, K-WIRE 1.1 X 150MM BLUNT,C1713,HCPCS,278,RC,,,,both,117.33,82.13,,,,,,,,,,,,,,,,,,,Other,25.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.29,25.29, MTP PLATE RIGHT,C1713,HCPCS,278,RC,,,,both,12606.9,8824.83,,,,,,,,,,,,,,,,,,,Other,2718.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2718.05,2718.05, SCREW LAG 3.5 X 32MM,C1713,HCPCS,278,RC,,,,both,1697.63,1188.34,,,,,,,,,,,,,,,,,,,Other,366.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,366.01,366.01, CONGRUENT TRIBIAL INSERT 3/4 14MM LEFT,278,RC,,,,,,both,4594.29,3216,,,,,,,,,,,,,,,,,,,Other,990.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,990.53,990.53, CONGRUENT TRIBIAL INSERT 5/16 12MM LEFT,278,RC,,,,,,both,4091.44,2864.01,,,,,,,,,,,,,,,,,,,Other,882.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,882.12,882.12, LEGACY KNEE POSTERIOR STABILIZED SIZE E,C1776,HCPCS,278,RC,,,,both,3098.86,2169.2,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, BASEPLATE CCM TIBIAL COCR 4 LEFT,278,RC,,,,,,both,8038.19,5626.73,,,,,,,,,,,,,,,,,,,Other,1733.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1733.03,1733.03, FEMORAL COMPONENT RLP POROUS COCR 5,278,RC,,,,,,both,13395.77,9377.04,,,,,,,,,,,,,,,,,,,Other,2888.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2888.13,2888.13, PEG PETELLA 26 MM,278,RC,,,,,,both,4359.14,3051.4,,,,,,,,,,,,,,,,,,,Other,939.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,939.83,939.83, TIBIAL INSERT PCL SIZE 3/4 10MM,278,RC,,,,,,both,4091.44,2864.01,,,,,,,,,,,,,,,,,,,Other,882.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,882.12,882.12, BASEPLATE CCM TIBIAL COCR 3 LEFT,278,RC,,,,,,both,9029.4,6320.58,,,,,,,,,,,,,,,,,,,Other,1946.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1946.74,1946.74, FEMORAL POROUS SZ 5 RIGHT,278,RC,,,,,,both,22302.18,15611.53,,,,,,,,,,,,,,,,,,,Other,4808.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4808.35,4808.35, TRAY TIBIAL TRAP SZ 5F/5T,278,RC,,,,,,both,13963.73,9774.61,,,,,,,,,,,,,,,,,,,Other,3010.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3010.58,3010.58, TIBIAL INSERT SIZE 5 15MM,278,RC,,,,,,both,7126.57,4988.6,,,,,,,,,,,,,,,,,,,Other,1536.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1536.49,1536.49, FEMORAL POROUS SZ 4 RIGHT,278,RC,,,,,,both,13715.56,9600.89,,,,,,,,,,,,,,,,,,,Other,2957.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2957.07,2957.07, PEG PETELLA,278,RC,,,,,,both,4359.14,3051.4,,,,,,,,,,,,,,,,,,,Other,939.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,939.83,939.83, PEG PATELLA,278,RC,,,,,,both,4540.02,3178.01,,,,,,,,,,,,,,,,,,,Other,978.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,978.82,978.82, "FEMORAL STEM SZ 15, 165MM",278,RC,,,,,,both,18729.48,13110.64,,,,,,,,,,,,,,,,,,,Other,4038.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4038.08,4038.08, BIPOLAR COMPONENT,278,RC,,,,,,both,4937.94,3456.56,,,,,,,,,,,,,,,,,,,Other,1064.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1064.62,1064.62, PROLONG HIGHLY CROSSLINKED POLYETHYLENE,C1776,HCPCS,278,RC,,,,both,1978.48,1384.94,,,,,,,,,,,,,,,,,,,Other,426.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,426.56,426.56, LEGACY KNEE POSTERIOR STABILIZED,C1776,HCPCS,278,RC,,,,both,3098.86,2169.2,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, TAPER STEM PLUG NEXGEN,C1776,HCPCS,278,RC,,,,both,1633.73,1143.61,,,,,,,,,,,,,,,,,,,Other,352.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,352.23,352.23, LEGACY KNE POSTERIOR STABILIZED,C1776,HCPCS,278,RC,,,,both,6954.63,4868.24,,,,,,,,,,,,,,,,,,,Other,1499.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1499.42,1499.42, PALACOS R+G 1X40 SINGLE BONE CEMENT,C1713,HCPCS,278,RC,,,,both,1011.81,708.27,,,,,,,,,,,,,,,,,,,Other,218.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,218.15,218.15, PATELLA REAMING BLADE SIZE 41,272,RC,,,,,,both,509.35,356.55,,,,,,,,,,,,,,,,,,,Other,109.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,109.82,109.82, STEMMED TIBIAL COMPONENT PRECOAT SIZE 5,C1776,HCPCS,278,RC,,,,both,3349.93,2344.95,,,,,,,,,,,,,,,,,,,Other,722.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,722.24,722.24, LEGACY KNEE POSTERIOR STABILIZED SIZE E,C1776,HCPCS,278,RC,,,,both,3098.86,2169.2,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, STEMMED TIBIAL COMPONENT PRECOAT SIZE 4,C1776,HCPCS,278,RC,,,,both,3349.93,2344.95,,,,,,,,,,,,,,,,,,,Other,722.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,722.24,722.24, ALL-POLY PATELLA 32MM,C1776,HCPCS,278,RC,,,,both,1978.48,1384.94,,,,,,,,,,,,,,,,,,,Other,426.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,426.56,426.56, LEGACY KNEE POSTERIOR STABILIZED SIZE C,C1776,HCPCS,278,RC,,,,both,3098.86,2169.2,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, LEGACY KNE POSTERIOR STABILIZED SIZE D,C1776,HCPCS,278,RC,,,,both,6954.63,4868.24,,,,,,,,,,,,,,,,,,,Other,1499.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1499.42,1499.42, "NEXGEN PROLONG ALLPOLY PATELLA, 29MM",C1776,HCPCS,278,RC,,,,both,1978.48,1384.94,,,,,,,,,,,,,,,,,,,Other,426.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,426.56,426.56, PATELLA REAMER BLADE SIZE 38,272,RC,,,,,,both,509.35,356.55,,,,,,,,,,,,,,,,,,,Other,109.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,109.82,109.82, LEGACY KNE POSTERIOR STABILIZED SIZE R-L,C1776,HCPCS,278,RC,,,,both,6954.63,4868.24,,,,,,,,,,,,,,,,,,,Other,1499.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1499.42,1499.42, NEXGEN PRECOAT STEMTIBIAL PLATE SZ 4,C1776,HCPCS,278,RC,,,,both,3349.93,2344.95,,,,,,,,,,,,,,,,,,,Other,722.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,722.24,722.24, LEGACY KNEE POSTERIOR STABILIZED SZ CD,C1776,HCPCS,278,RC,,,,both,4072.94,2851.06,,,,,,,,,,,,,,,,,,,Other,878.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,878.13,878.13, LEGACY KNE POSTERIOR STABILIZED SIZE D-L,C1776,HCPCS,278,RC,,,,both,6954.63,4868.24,,,,,,,,,,,,,,,,,,,Other,1499.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1499.42,1499.42, STEMMED TIBIAL COMPONENT PRECOAT SIZE 6,C1776,HCPCS,278,RC,,,,both,3349.93,2344.95,,,,,,,,,,,,,,,,,,,Other,722.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,722.24,722.24, PATELLA REAMER BLADE SIZE 35,272,RC,,,,,,both,494.51,346.16,,,,,,,,,,,,,,,,,,,Other,106.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,106.61,106.61, REFOBACIN BONE CEMENT R 1X40 US,C1713,HCPCS,278,RC,,,,both,617.38,432.17,,,,,,,,,,,,,,,,,,,Other,133.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,133.1,133.1, NEXGEN LPS-FLEX FIXED PROLONG ART SUR CD,C1776,HCPCS,278,RC,,,,both,3098.86,2169.2,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, HEADLESS TROCAR DRILL PIN75MM,C1713,HCPCS,278,RC,,,,both,881.48,617.04,,,,,,,,,,,,,,,,,,,Other,190.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,190.05,190.05, NEXGEN LPS FLEX FIXED PROLONG ART SUR EF,C1776,HCPCS,278,RC,,,,both,3098.86,2169.2,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, CUP MAGNUM 580DX521D,278,RC,,,,,,both,19947.14,13963,,,,,,,,,,,,,,,,,,,Other,4300.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4300.6,4300.6, CUP MAGNUM PF 480DX42ID,278,RC,,,,,,both,21046.89,14732.82,,,,,,,,,,,,,,,,,,,Other,4537.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4537.71,4537.71, NEXGEN PRECOAT STEMMED TIBIAL PLATE SZ 3,C1776,HCPCS,278,RC,,,,both,3349.93,2344.95,,,,,,,,,,,,,,,,,,,Other,722.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,722.24,722.24, CUP MAGNUM PF 500DX44ID,278,RC,,,,,,both,22204.5,15543.15,,,,,,,,,,,,,,,,,,,Other,4787.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4787.29,4787.29, NEXGEN LPS FLEX FIXED PROLONG ART SUR CD,C1776,HCPCS,278,RC,,,,both,3098.86,2169.2,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, CUP MAGNUM 620DX561D M2A,278,RC,,,,,,both,19947.14,13963,,,,,,,,,,,,,,,,,,,Other,4300.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4300.6,4300.6, CUP MAGNUM 50ODX48ID,278,RC,,,,,,both,20721.3,14504.91,,,,,,,,,,,,,,,,,,,Other,4467.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4467.52,4467.52, MAGNUM PF CUP 50ODX46ID,278,RC,,,,,,both,22204.5,15543.15,,,,,,,,,,,,,,,,,,,Other,4787.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4787.29,4787.29, CUP MAGNUM 54ODX48ID,278,RC,,,,,,both,21046.89,14732.82,,,,,,,,,,,,,,,,,,,Other,4537.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4537.71,4537.71, ACT ARTIC HD ARCOM XL 28X44MM,278,RC,,,,,,both,9616,6731.2,,,,,,,,,,,,,,,,,,,Other,2073.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2073.21,2073.21, M2A MAGNUM PF CUP 50ODX44ID,278,RC,,,,,,both,22204.5,15543.15,,,,,,,,,,,,,,,,,,,Other,4787.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4787.29,4787.29, CUP MAGNUS 56ODX50ID,278,RC,,,,,,both,22204.5,15543.15,,,,,,,,,,,,,,,,,,,Other,4787.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4787.29,4787.29, NEXGEN LPS-FLEX FIXED PROLONG ART SUR CD,C1776,HCPCS,278,RC,,,,both,3098.86,2169.2,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, NEXGEN PRECOAT STEMMED TIBIAL PLATE SZ 2,C1776,HCPCS,278,RC,,,,both,4887.54,3421.28,,,,,,,,,,,,,,,,,,,Other,1053.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1053.75,1053.75, NEXGEN LPS FLEX FIXED PSIZE CD 12MM,C1776,HCPCS,278,RC,,,,both,3978.2,2784.74,,,,,,,,,,,,,,,,,,,Other,857.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,857.7,857.7, NEXGEN LPS FLEX FIXED PROLONG ART SUR GH,C1776,HCPCS,278,RC,,,,both,3098.86,2169.2,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, NEXGEN LPS FLEX FIXED PROLONG ART SUR GH,C1776,HCPCS,278,RC,,,,both,3098.86,2169.2,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, NEXGEN LPS-FLEX FIXED PROLONG ART SUR CD,C1776,HCPCS,278,RC,,,,both,3098.86,2169.2,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, MAGNUM 12/14 TPR 52-60 STD,278,RC,,,,,,both,2098.17,1468.72,,,,,,,,,,,,,,,,,,,Other,452.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,452.37,452.37, MAGNUM 12/14 TPR 52-60 +9,278,RC,,,,,,both,2098.17,1468.72,,,,,,,,,,,,,,,,,,,Other,452.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,452.37,452.37, ARCOS 13X175M BRCH BODY STD,C1776,HCPCS,278,RC,,,,both,7117.04,4981.93,,,,,,,,,,,,,,,,,,,Other,1534.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1534.44,1534.44, ARCOS 12X175MM BRCH BODY STD,C1776,HCPCS,278,RC,,,,both,7117.04,4981.93,,,,,,,,,,,,,,,,,,,Other,1534.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1534.44,1534.44, NEXGEN LPS FLEX FIXED PROLONG ART SUR GH,C1776,HCPCS,278,RC,,,,both,3098.86,2169.2,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, NEXGEN LPS FLEX FIXED PROLONG ART SUR EF,C1776,HCPCS,278,RC,,,,both,3098.86,2169.2,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, ACROS 1PC 14X175MM BRCH BODY STD,C1776,HCPCS,278,RC,,,,both,6909.75,4836.83,,,,,,,,,,,,,,,,,,,Other,1489.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1489.75,1489.75, 28MM MOD HD STD NECK TP1 TAPER,278,RC,,,,,,both,1457.71,1020.4,,,,,,,,,,,,,,,,,,,Other,314.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,314.29,314.29, PSN 2.5MM FEMALE SCREW 25MM,C1713,HCPCS,278,RC,,,,both,480.19,336.13,,,,,,,,,,,,,,,,,,,Other,103.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,103.53,103.53, PSN FEM PS CMT CCR NRW SIZE 5 L,C1776,HCPCS,278,RC,,,,both,6002.32,4201.62,,,,,,,,,,,,,,,,,,,Other,1294.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1294.1,1294.1, CER BIOLOXD OPTION HD 28MM,278,RC,,,,,,both,4801.86,3361.3,,,,,,,,,,,,,,,,,,,Other,1035.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1035.28,1035.28, CER OPTION 12/14 TPR SLEEVE +4,278,RC,,,,,,both,1211.88,848.32,,,,,,,,,,,,,,,,,,,Other,261.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,261.28,261.28, PSN ASF PS 16MM VE L 3-5 CD,C1776,HCPCS,278,RC,,,,both,3098.86,2169.2,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, PSN TIB STM 5 DEG SIZE D L,C1776,HCPCS,278,RC,,,,both,3086.91,2160.84,,,,,,,,,,,,,,,,,,,Other,665.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,665.54,665.54, ALL POLY PAT VE 32MM DIA,C1776,HCPCS,278,RC,,,,both,1457.71,1020.4,,,,,,,,,,,,,,,,,,,Other,314.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,314.29,314.29, ARCOS 11X175MM BRCH BODY STD,C1776,HCPCS,278,RC,,,,both,6909.75,4836.83,,,,,,,,,,,,,,,,,,,Other,1489.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1489.75,1489.75, PSN FEM PS CMT CCR STD SZ8 L,C1776,HCPCS,278,RC,,,,both,6002.32,4201.62,,,,,,,,,,,,,,,,,,,Other,1294.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1294.1,1294.1, PSN ASF PS 10MM VE L 6-9 GH,C1776,HCPCS,278,RC,,,,both,2915.41,2040.79,,,,,,,,,,,,,,,,,,,Other,628.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,628.56,628.56, PSN TIB STM 5 DEG SZ G L,C1776,HCPCS,278,RC,,,,both,3086.91,2160.84,,,,,,,,,,,,,,,,,,,Other,665.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,665.54,665.54, ALL POLY PAT VE 38 MM DIA,C1776,HCPCS,278,RC,,,,both,1978.5,1384.95,,,,,,,,,,,,,,,,,,,Other,426.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,426.56,426.56, MAGNUM MOD HD SZ 52MM,278,RC,,,,,,both,7567.91,5297.54,,,,,,,,,,,,,,,,,,,Other,1631.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1631.64,1631.64, MAGNUM MOD HD SZ 56MM,278,RC,,,,,,both,7567.91,5297.54,,,,,,,,,,,,,,,,,,,Other,1631.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1631.64,1631.64, CUP MAGNUM M2A 12/14 TPR 42-50+3,278,RC,,,,,,both,2213.94,1549.76,,,,,,,,,,,,,,,,,,,Other,477.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,477.33,477.33, MAGUM M2A MOD HD SZ 48MM,278,RC,,,,,,both,7987.54,5591.28,,,,,,,,,,,,,,,,,,,Other,1722.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1722.11,1722.11, PSN FEM PS CMT CCR STD SZ10 L,C1776,HCPCS,278,RC,,,,both,6002.32,4201.62,,,,,,,,,,,,,,,,,,,Other,1294.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1294.1,1294.1, PSN ASF PS 12MM VE L 10-12 GH,C1776,HCPCS,278,RC,,,,both,2915.41,2040.79,,,,,,,,,,,,,,,,,,,Other,628.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,628.56,628.56, ALL POLY PAT VE 41 MM DIA,C1776,HCPCS,278,RC,,,,both,1457.71,1020.4,,,,,,,,,,,,,,,,,,,Other,314.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,314.29,314.29, "BIOLOX DELTA FEM HEAD, 32MM, +0MM",C1776,HCPCS,278,RC,,,,both,2486.68,1740.68,,,,,,,,,,,,,,,,,,,Other,536.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,536.13,536.13, PSN FEM PS CMT CRR NRW SZ9 R,C1776,HCPCS,278,RC,,,,both,6002.32,4201.62,,,,,,,,,,,,,,,,,,,Other,1294.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1294.1,1294.1, PSN TIB STM 5 DEG SZ E R,C1776,HCPCS,278,RC,,,,both,2997,2097.9,,,,,,,,,,,,,,,,,,,Other,646.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,646.15,646.15, ACT ARTIC E1 28MM ID X 42MM OD,278,RC,,,,,,both,10103.81,7072.67,,,,,,,,,,,,,,,,,,,Other,2178.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2178.38,2178.38, PSN ASF PS 10MM VE R 6-9 EF,C1776,HCPCS,278,RC,,,,both,2915.41,2040.79,,,,,,,,,,,,,,,,,,,Other,628.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,628.56,628.56, ALL POLY PAT VE 35 MM DIA,C1776,HCPCS,278,RC,,,,both,1457.71,1020.4,,,,,,,,,,,,,,,,,,,Other,314.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,314.29,314.29, PSN FEM PS CMT CRR NRW SZ8 R,C1776,HCPCS,278,RC,,,,both,5827.5,4079.25,,,,,,,,,,,,,,,,,,,Other,1256.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1256.41,1256.41, PSN ASF PS 16MM VE L 6-9 CD,C1776,HCPCS,278,RC,,,,both,3098.86,2169.2,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, PSN ASF PS 11MM VE R 6-9 EF,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, PSN FEM PS CMT CCR NRW SIZE 6 R,C1776,HCPCS,278,RC,,,,both,6954.74,4868.32,,,,,,,,,,,,,,,,,,,Other,1499.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1499.44,1499.44, M/L TAPER KINECTIV STEM SIZE 12.5,C1776,HCPCS,278,RC,,,,both,6711.18,4697.83,,,,,,,,,,,,,,,,,,,Other,1446.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1446.93,1446.93, PSN FEM PS CMT CCR STD SZ10 R,C1776,HCPCS,278,RC,,,,both,6002.32,4201.62,,,,,,,,,,,,,,,,,,,Other,1294.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1294.1,1294.1, PSN FEM PS CMT CCR STD SZ11 R,C1776,HCPCS,278,RC,,,,both,6002.34,4201.64,,,,,,,,,,,,,,,,,,,Other,1294.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1294.1,1294.1, PSN ASF PS 10MM VE R 10-12 GH,C1776,HCPCS,278,RC,,,,both,2915.41,2040.79,,,,,,,,,,,,,,,,,,,Other,628.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,628.56,628.56, PSN ASF PS 10MM VE L 6-9 EF,C1776,HCPCS,278,RC,,,,both,2915.41,2040.79,,,,,,,,,,,,,,,,,,,Other,628.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,628.56,628.56, BF HUMERAL HEAD 15MMX46MM,C1776,HCPCS,278,RC,,,,both,4503.65,3152.56,,,,,,,,,,,,,,,,,,,Other,970.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,970.98,970.98, TM HUMERAL STEM 48 DEG 11MMX130MM,C1776,HCPCS,278,RC,,,,both,11518.7,8063.09,,,,,,,,,,,,,,,,,,,Other,2483.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2483.43,2483.43, PSN FEM PS CMT CCR STD SZ9 R,C1776,HCPCS,278,RC,,,,both,6002.32,4201.62,,,,,,,,,,,,,,,,,,,Other,1294.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1294.1,1294.1, PSN TIB STM 5 DEG SZ G R,C1776,HCPCS,278,RC,,,,both,3086.91,2160.84,,,,,,,,,,,,,,,,,,,Other,665.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,665.54,665.54, PSN ASF PS 11MM VE R 6-9 GH,C1776,HCPCS,278,RC,,,,both,3098.91,2169.24,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, PSN ASF PS 10MM VE L 10-12 GH,C1776,HCPCS,278,RC,,,,both,3098.91,2169.24,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, PSN ASF PS 12MM VE R 10-12 GH,C1776,HCPCS,278,RC,,,,both,2915.41,2040.79,,,,,,,,,,,,,,,,,,,Other,628.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,628.56,628.56, PSN FEM PS CMT CCR STD SZ12 R,C1776,HCPCS,278,RC,,,,both,5827.5,4079.25,,,,,,,,,,,,,,,,,,,Other,1256.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1256.41,1256.41, PSN ASF PS 11MM VE R 10-12 GH,278,RC,,,,,,both,3098.91,2169.24,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, ALL POLY PAT VE 38 MM DIA,C1776,HCPCS,278,RC,,,,both,1457.71,1020.4,,,,,,,,,,,,,,,,,,,Other,314.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,314.29,314.29, PSN FEM PS CMT CCR STD SZ11 L,C1776,HCPCS,278,RC,,,,both,6002.32,4201.62,,,,,,,,,,,,,,,,,,,Other,1294.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1294.1,1294.1, PSN FEM PS CMT CCR STD SZ7 L,C1776,HCPCS,278,RC,,,,both,6002.32,4201.62,,,,,,,,,,,,,,,,,,,Other,1294.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1294.1,1294.1, PSN ASF PS 12MM VE L 6-9 EF,C1776,HCPCS,278,RC,,,,both,2915.41,2040.79,,,,,,,,,,,,,,,,,,,Other,628.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,628.56,628.56, PSN ASF PS 10MM VE R 6-9 GH,C1776,HCPCS,278,RC,,,,both,2915.41,2040.79,,,,,,,,,,,,,,,,,,,Other,628.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,628.56,628.56, GEMINUS VOLAR DISTAL RADIUS,C1713,HCPCS,278,RC,,,,both,3700.86,2590.6,,,,,,,,,,,,,,,,,,,Other,797.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,797.91,797.91, SMOOTH PEG LOCKING 2.00X16MM,C1713,HCPCS,278,RC,,,,both,380.35,266.25,,,,,,,,,,,,,,,,,,,Other,82.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,82.01,82.01, SMOOTH PEG LOCKING 2.0X18MM,C1713,HCPCS,278,RC,,,,both,380.35,266.25,,,,,,,,,,,,,,,,,,,Other,82.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,82.01,82.01, SMOOTH PEG LOCKING 2.7X22MM,C1713,HCPCS,278,RC,,,,both,408.16,285.71,,,,,,,,,,,,,,,,,,,Other,88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,88,88, HIGH COMPRESSION LOCKING PEG 2.7X22MM,C1713,HCPCS,278,RC,,,,both,439.03,307.32,,,,,,,,,,,,,,,,,,,Other,94.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,94.66,94.66, SCREW CORTICAL LOCKING 3.5X10MM,C1713,HCPCS,278,RC,,,,both,404.73,283.31,,,,,,,,,,,,,,,,,,,Other,87.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,87.26,87.26, SCREW CORTICAL LOCKING 3.5X12MM,C1713,HCPCS,278,RC,,,,both,404.73,283.31,,,,,,,,,,,,,,,,,,,Other,87.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,87.26,87.26, SCREW CORTICAL NON LOCKING 3.5X10MM,C1713,HCPCS,278,RC,,,,both,397.87,278.51,,,,,,,,,,,,,,,,,,,Other,85.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,85.78,85.78, CONTINUUM VIVACIT-E NEUTRAL LINER LL 32X,C1776,HCPCS,278,RC,,,,both,3086.91,2160.84,,,,,,,,,,,,,,,,,,,Other,665.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,665.54,665.54, 32MM MOD HEAD COCR +6mm NECK,C1776,HCPCS,278,RC,,,,both,1396.29,977.4,,,,,,,,,,,,,,,,,,,Other,301.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,301.04,301.04, ARCOS 12X175MM BRCH BODY HI,C1776,HCPCS,278,RC,,,,both,11318.49,7922.94,,,,,,,,,,,,,,,,,,,Other,2440.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2440.27,2440.27, "CONTINUUM VIVACIT-E NEUTRAL LINER, KK 32",C1776,HCPCS,278,RC,,,,both,3267.48,2287.24,,,,,,,,,,,,,,,,,,,Other,704.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,704.47,704.47, CONTINUUM VIVACIT-E NEUTRAL LINER II 32X,C1776,HCPCS,278,RC,,,,both,3086.91,2160.84,,,,,,,,,,,,,,,,,,,Other,665.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,665.54,665.54, PSN FEM PS CMT CCR NRW SZ7 R,C1776,HCPCS,278,RC,,,,both,5827.5,4079.25,,,,,,,,,,,,,,,,,,,Other,1256.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1256.41,1256.41, PSN ASF PS 12MM VE L 6-9 EF,C1776,HCPCS,278,RC,,,,both,3098.91,2169.24,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, "CABLE GRIP SYS,4X40MM",278,RC,,,,,,both,2052.38,1436.67,,,,,,,,,,,,,,,,,,,Other,442.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,442.49,442.49, CABLE GRIP SYS W/TWO CRIMP 4X35MM,278,RC,,,,,,both,2052.38,1436.67,,,,,,,,,,,,,,,,,,,Other,442.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,442.49,442.49, PSN ASF PS 14MM VE L 10-12 GH,C1776,HCPCS,278,RC,,,,both,2915.41,2040.79,,,,,,,,,,,,,,,,,,,Other,628.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,628.56,628.56, DRESSING EPIFIX 2X3,Q4186,HCPCS,636,RC,,,,both,653.79,457.65,,,,,,,,,,,,,,,,,,,Other,140.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.87,140.95, PIN GUIDE 3.2 MM,C1713,HCPCS,278,RC,,,,both,658.53,460.97,,,,,,,,,,,,,,,,,,,Other,141.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,141.98,141.98, SCREW LAG 85MM,C1713,HCPCS,278,RC,,,,both,966.06,676.24,,,,,,,,,,,,,,,,,,,Other,208.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,208.28,208.28, SCREW 4.7 X 25.4 MM,C1713,HCPCS,278,RC,,,,both,201.34,140.94,,,,,,,,,,,,,,,,,,,Other,43.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.4,43.4, SCREW 4.5 X 44MM,278,RC,,,,,,both,144.59,101.21,,,,,,,,,,,,,,,,,,,Other,31.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,31.17,31.17, SCREW 4.5 X 38MM,278,RC,,,,,,both,144.59,101.21,,,,,,,,,,,,,,,,,,,Other,31.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,31.17,31.17, SCREW 2.4 X 16MM CANNOLATED,278,RC,,,,,,both,560.71,392.5,,,,,,,,,,,,,,,,,,,Other,120.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,120.89,120.89, AFB1115-AVAFLEXBALLOON 11G 15MM,C1889,HCPCS,278,RC,,,,both,8833.71,6183.6,,,,,,,,,,,,,,,,,,,Other,1904.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1904.55,1904.55, AUTOPLEX W/VERTAPLEX HV,C1713,HCPCS,278,RC,,,,both,2683.98,1878.79,,,,,,,,,,,,,,,,,,,Other,578.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,578.67,578.67, IVAS 11G BIOPSY,272,RC,,,,,,both,274.66,192.26,,,,,,,,,,,,,,,,,,,Other,59.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,59.22,59.22, CURETTE 11G,C1889,HCPCS,278,RC,,,,both,2027.86,1419.5,,,,,,,,,,,,,,,,,,,Other,437.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,437.21,437.21, CONSIGNMENT 11G IVAS ACCESS CANNULA,C1889,HCPCS,278,RC,,,,both,190.11,133.08,,,,,,,,,,,,,,,,,,,Other,40.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.98,40.98, 11G 20MM AVAFLEX KIT,C1889,HCPCS,278,RC,,,,both,8833.71,6183.6,,,,,,,,,,,,,,,,,,,Other,1904.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1904.55,1904.55, CONTINUUM VIVACIT-E NEUTRAL LINER GG 32X,C1776,HCPCS,278,RC,,,,both,3267.48,2287.24,,,,,,,,,,,,,,,,,,,Other,704.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,704.47,704.47, PSN ASF PS 10MM VE L 10-11 EF,C1776,HCPCS,278,RC,,,,both,3098.91,2169.24,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, PSN TIB STM 5 DEG SIZE F L,C1776,HCPCS,278,RC,,,,both,3086.91,2160.84,,,,,,,,,,,,,,,,,,,Other,665.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,665.54,665.54, PSN ASF PS 14MM VE L 6-9 EF,C1776,HCPCS,278,RC,,,,both,2915.41,2040.79,,,,,,,,,,,,,,,,,,,Other,628.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,628.56,628.56, PSN TIB STM 5 DEG SZ E L,C1776,HCPCS,278,RC,,,,both,3086.91,2160.84,,,,,,,,,,,,,,,,,,,Other,665.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,665.54,665.54, PSN ASF PS 14MM VE R 6-9 EF,C1776,HCPCS,278,RC,,,,both,3098.91,2169.24,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, CER BIOLOXD OPTION HD 32MM,C1776,HCPCS,278,RC,,,,both,4801.86,3361.3,,,,,,,,,,,,,,,,,,,Other,1035.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1035.28,1035.28, CER OPTION TYPE 1 TPR SLEEVE +3,C1889,HCPCS,278,RC,,,,both,342.99,240.09,,,,,,,,,,,,,,,,,,,Other,73.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,73.95,73.95, "CONTINUUM VIVACIT-E NEUTRAL LINER, JJ 3",C1776,HCPCS,278,RC,,,,both,3267.48,2287.24,,,,,,,,,,,,,,,,,,,Other,704.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,704.47,704.47, CER BIOLOXD OPTION HD 36MM,C1776,HCPCS,278,RC,,,,both,4801.86,3361.3,,,,,,,,,,,,,,,,,,,Other,1035.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1035.28,1035.28, CER OPTION TYPE 1 TPR SLEEVE +6,C1889,HCPCS,278,RC,,,,both,333,233.1,,,,,,,,,,,,,,,,,,,Other,71.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.79,71.79, COMP RVS 2.7 MM DIA DRL,272,RC,,,,,,both,795.52,556.86,,,,,,,,,,,,,,,,,,,Other,171.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,171.51,171.51, COMP REV SHLDR 9 IN STEINMANN,C1713,HCPCS,278,RC,,,,both,546.11,382.28,,,,,,,,,,,,,,,,,,,Other,117.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,117.74,117.74, COMP RVS 3.2 MM DRL,272,RC,,,,,,both,580.4,406.28,,,,,,,,,,,,,,,,,,,Other,125.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,125.14,125.14, COMP RVS 25MM BSPLT HA+ADPTR,C1776,HCPCS,278,RC,,,,both,5916.58,4141.61,,,,,,,,,,,,,,,,,,,Other,1275.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1275.62,1275.62, HMRL BEARING 36 MM + 3 VITE,C1713,HCPCS,278,RC,,,,both,6311.02,4417.71,,,,,,,,,,,,,,,,,,,Other,1360.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1360.65,1360.65, HMRL TRAY +3 STD,C1776,HCPCS,278,RC,,,,both,5455.09,3818.56,,,,,,,,,,,,,,,,,,,Other,1176.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1176.12,1176.12, COMP NLK SCR 3.5HEX 4.75X25 ST,C1713,HCPCS,278,RC,,,,both,499.23,349.46,,,,,,,,,,,,,,,,,,,Other,107.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,107.63,107.63, COMP NLK SCR 3.5HEX 4.75X20 ST,C1713,HCPCS,278,RC,,,,both,485.16,339.61,,,,,,,,,,,,,,,,,,,Other,104.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,104.61,104.61, COMP RVRS SHLDR GLNSP STD 36MM,C1776,HCPCS,278,RC,,,,both,4721.43,3305,,,,,,,,,,,,,,,,,,,Other,1017.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1017.94,1017.94, COMP RVS CNTRL 6.5X25MM ST/RST,C1713,HCPCS,278,RC,,,,both,477.27,334.09,,,,,,,,,,,,,,,,,,,Other,102.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,102.9,102.9, AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 15MM,C1713,HCPCS,278,RC,,,,both,2044.22,1430.95,,,,,,,,,,,,,,,,,,,Other,440.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,440.74,440.74, CANNULATED COMPRESSION SCREW W/ S.S.,C1713,HCPCS,278,RC,,,,both,1262.14,883.5,,,,,,,,,,,,,,,,,,,Other,272.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,272.12,272.12, AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 17MM,C1713,HCPCS,278,RC,,,,both,2044.22,1430.95,,,,,,,,,,,,,,,,,,,Other,440.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,440.74,440.74, AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 16MM,C1713,HCPCS,278,RC,,,,both,2103.51,1472.46,,,,,,,,,,,,,,,,,,,Other,453.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,453.51,453.51, COUNTERSINK 2.0 - 2.5MM CANNULATED,A4649,HCPCS,272,RC,,,,both,1852.92,1297.04,,,,,,,,,,,,,,,,,,,Other,399.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,399.49,399.49, MRI STERILE SHORT OSTEOTOME BLADE 12MM,272,RC,,,,,,both,395.29,276.7,,,,,,,,,,,,,,,,,,,Other,85.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,85.22,85.22, COMP RV SHLDR GD AND BN R,C1713,HCPCS,278,RC,,,,both,4023.48,2816.44,,,,,,,,,,,,,,,,,,,Other,867.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,867.47,867.47, COMP LK SCR 3.5 HEX 4.75X20 ST,C1713,HCPCS,278,RC,,,,both,499.23,349.46,,,,,,,,,,,,,,,,,,,Other,107.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,107.63,107.63, COMP PRIMARY STEM 9MM MINI,C1776,HCPCS,278,RC,,,,both,13977.53,9784.27,,,,,,,,,,,,,,,,,,,Other,3013.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3013.56,3013.56, HMRL BEARING 36MM STD VITE,C1713,HCPCS,278,RC,,,,both,6494.04,4545.83,,,,,,,,,,,,,,,,,,,Other,1400.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1400.12,1400.12, COMP LK SCR 3.5 HEX 4.75X30 ST,C1713,HCPCS,278,RC,,,,both,499.23,349.46,,,,,,,,,,,,,,,,,,,Other,107.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,107.63,107.63, PSN ASF PS 13MM VE R 10-12 EF,C1776,HCPCS,278,RC,,,,both,3188.78,2232.15,,,,,,,,,,,,,,,,,,,Other,687.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,687.5,687.5, CER OPTION TYPE 1 TPR SLEEVE 0MM,C1889,HCPCS,278,RC,,,,both,342.99,240.09,,,,,,,,,,,,,,,,,,,Other,73.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,73.95,73.95, PSN ASF PS 16MM VE R 10-12 GH,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, PSN FEM CR POR CCR STD SZ8 R,C1776,HCPCS,278,RC,,,,both,11044.28,7731,,,,,,,,,,,,,,,,,,,Other,2381.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2381.15,2381.15, PLATE 135 DEGREE 3 HOLE,C1713,HCPCS,278,RC,,,,both,1485.64,1039.95,,,,,,,,,,,,,,,,,,,Other,320.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,320.3,320.3, SCREW CORTICAL NON LOCKING 3.5X12MM,C1713,HCPCS,278,RC,,,,both,397.87,278.51,,,,,,,,,,,,,,,,,,,Other,85.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,85.78,85.78, K-WIRE 1.6X127MM,C1769,HCPCS,278,RC,,,,both,147.81,103.47,,,,,,,,,,,,,,,,,,,Other,31.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,31.87,31.87, DRILL SOLID SIDE CUTTING 2X40MM,C1713,HCPCS,278,RC,,,,both,473.33,331.33,,,,,,,,,,,,,,,,,,,Other,102.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,102.05,102.05, DRILL SOLID SIDE CUTTING 2.5X40MM,C1713,HCPCS,278,RC,,,,both,483.62,338.53,,,,,,,,,,,,,,,,,,,Other,104.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,104.27,104.27, DRIVER PEG TORQUE,C1713,HCPCS,278,RC,,,,both,476.76,333.73,,,,,,,,,,,,,,,,,,,Other,102.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,102.79,102.79, NITINOL SPEED 18X18X15MM,278,RC,,,,,,both,5408.24,3785.77,,,,,,,,,,,,,,,,,,,Other,1166.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1166.01,1166.01, GUIDE,272,RC,,,,,,both,1428.93,1000.25,,,,,,,,,,,,,,,,,,,Other,308.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,308.07,308.07, XEMPLIFI DBM PUTTY 5 CC,C1713,HCPCS,278,RC,,,,both,3529.37,2470.56,,,,,,,,,,,,,,,,,,,Other,760.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,760.93,760.93, CREO MIS 5.5X 50 MM CURVED ROD TITANIUM,C1713,HCPCS,278,RC,,,,both,749.25,524.48,,,,,,,,,,,,,,,,,,,Other,161.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,161.54,161.54, CREO MIS 45 MM CURVED ROD TITANIUM ALLOY,C1713,HCPCS,278,RC,,,,both,749.25,524.48,,,,,,,,,,,,,,,,,,,Other,161.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,161.54,161.54, CREO MIS 5.5X40MM CURVED ROD TITANIUM AL,C1713,HCPCS,278,RC,,,,both,1318.37,922.86,,,,,,,,,,,,,,,,,,,Other,284.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,284.24,284.24, CREO AMP 6.5X45MM MODULAR CANNULATED SCR,C1713,HCPCS,278,RC,,,,both,2057.94,1440.56,,,,,,,,,,,,,,,,,,,Other,443.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,443.7,443.7, SUSTAIN RADIOLUCENT SPACER 8X22 8MM,278,RC,,,,,,both,20801.21,14560.85,,,,,,,,,,,,,,,,,,,Other,4484.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4484.74,4484.74, CREO MIS MODULAR POLYAXIAL TULIP 30MM RE,C1713,HCPCS,278,RC,,,,both,1498.5,1048.95,,,,,,,,,,,,,,,,,,,Other,323.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,323.08,323.08, COLONIAL ACDF SPACER 12X14 7DEGREE 7MM,C1889,HCPCS,278,RC,,,,both,3429.9,2400.93,,,,,,,,,,,,,,,,,,,Other,739.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,739.49,739.49, XEMPLIFI DBM PUTTY 3 CC,278,RC,,,,,,both,2441.87,1709.31,,,,,,,,,,,,,,,,,,,Other,526.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,526.47,526.47, COLONIAL ACDF SPACER 12X14 7DEGREE 6MM,C1889,HCPCS,278,RC,,,,both,3529.37,2470.56,,,,,,,,,,,,,,,,,,,Other,760.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,760.93,760.93, COLONIAL ACDF SPACER 12X14 7DEGREE 10MM,C1889,HCPCS,278,RC,,,,both,3497.57,2448.3,,,,,,,,,,,,,,,,,,,Other,754.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,754.08,754.08, BONE SCREW 4.2MM VARIABLE ANGLE SELF DRI,C1713,HCPCS,278,RC,,,,both,771.73,540.21,,,,,,,,,,,,,,,,,,,Other,166.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,166.38,166.38, RESONATE ANTERIOR CERVICAL PLATE 2-LEVEL,L8699,HCPCS,278,RC,,,,both,3399,2379.3,,,,,,,,,,,,,,,,,,,Other,732.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,732.82,732.82, XEMPLIFI DBM PUTTY 1 CC,C1713,HCPCS,278,RC,,,,both,857.48,600.24,,,,,,,,,,,,,,,,,,,Other,184.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,184.88,184.88, RESONATE ANTERIOR CERVICAL PLATE 1-LEVEL,L8699,HCPCS,278,RC,,,,both,3399,2379.3,,,,,,,,,,,,,,,,,,,Other,732.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,732.82,732.82, BONE SCREW 4.2MM VARIABLE ANGLE SELF DRI,C1713,HCPCS,278,RC,,,,both,771.73,540.21,,,,,,,,,,,,,,,,,,,Other,166.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,166.38,166.38, RESONATE ANTERIOR CERVICAL PLATE 1-LEVEL,L8699,HCPCS,278,RC,,,,both,3399,2379.3,,,,,,,,,,,,,,,,,,,Other,732.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,732.82,732.82, RESONATE ANTERIOR CERVICAL PLATE 2-LEVEL,L8699,HCPCS,278,RC,,,,both,3399,2379.3,,,,,,,,,,,,,,,,,,,Other,732.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,732.82,732.82, DISTRACTION PIN 12MM,C1713,HCPCS,278,RC,,,,both,176.47,123.53,,,,,,,,,,,,,,,,,,,Other,38.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,38.04,38.04, RESONATE ANTERIOR CERVICAL PLATE 1-LEVEL,L8699,HCPCS,278,RC,,,,both,3497.57,2448.3,,,,,,,,,,,,,,,,,,,Other,754.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,754.08,754.08, DISTRACTION PIN 14MM,C1713,HCPCS,278,RC,,,,both,176.47,123.53,,,,,,,,,,,,,,,,,,,Other,38.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,38.04,38.04, BONE SCREW 4.2MM VARIABLE ANGLE SELF DRI,C1713,HCPCS,278,RC,,,,both,794.11,555.88,,,,,,,,,,,,,,,,,,,Other,171.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,171.21,171.21, COLONIAL ACDF SPACER 12X14 0DEGREE 6MM,C1889,HCPCS,278,RC,,,,both,3497.57,2448.3,,,,,,,,,,,,,,,,,,,Other,754.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,754.08,754.08, COLONIAL ACDF SPACER 12X14 7DEGREE 5MM,C1889,HCPCS,278,RC,,,,both,3497.57,2448.3,,,,,,,,,,,,,,,,,,,Other,754.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,754.08,754.08, COLONIAL ACDF SPACER 12X14 0 DEGREE 5MM,C1889,HCPCS,278,RC,,,,both,3529.37,2470.56,,,,,,,,,,,,,,,,,,,Other,760.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,760.93,760.93, RESONATE ANTERIOR CERVICAL PLATE 3-LEVEL,L8699,HCPCS,278,RC,,,,both,3529.37,2470.56,,,,,,,,,,,,,,,,,,,Other,760.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,760.93,760.93, PSN TIB STM 5 DEG SIZE D R,C1776,HCPCS,278,RC,,,,both,3086.91,2160.84,,,,,,,,,,,,,,,,,,,Other,665.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,665.54,665.54, EPIFIX 2.0x2.0 CM,Q4186,HCPCS,636,RC,,,,both,845.04,591.53,,,,,,,,,,,,,,,,,,,Other,182.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.87,182.19, PSN FEM PS CMT CRR NRW SZ6 L,C1776,HCPCS,278,RC,,,,both,6002.32,4201.62,,,,,,,,,,,,,,,,,,,Other,1294.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1294.1,1294.1, PSN FEM PS CMT CRR NRW SZ5 R,C1776,HCPCS,278,RC,,,,both,6002.32,4201.62,,,,,,,,,,,,,,,,,,,Other,1294.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1294.1,1294.1, PSN FEM PS CMT CRR NRW SZ6 R,C1776,HCPCS,278,RC,,,,both,6002.32,4201.62,,,,,,,,,,,,,,,,,,,Other,1294.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1294.1,1294.1, PSN MC VE ASF R 10MM 8-11 GH,C1776,HCPCS,278,RC,,,,both,3098.92,2169.24,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, PSN ASF PS 12MM VE R 6-9 CD,C1776,HCPCS,278,RC,,,,both,2915.41,2040.79,,,,,,,,,,,,,,,,,,,Other,628.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,628.56,628.56, PSN ASF PS 10MM VE R 6-9 CD,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, PSN ASF PS 12 MM VE R 3-5 CD,C1776,HCPCS,278,RC,,,,both,2915.41,2040.79,,,,,,,,,,,,,,,,,,,Other,628.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,628.56,628.56, PSN ASF PS 11MM VE L 3-5 CD,C1776,HCPCS,278,RC,,,,both,3098.91,2169.24,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, EPIFIX 5.0X6.0 CM,Q4186,HCPCS,636,RC,,,,both,689.96,482.97,,,,,,,,,,,,,,,,,,,Other,148.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.87,148.75, EPIFIX 4.0X4.0 CM,Q4186,HCPCS,636,RC,,,,both,673.12,471.18,,,,,,,,,,,,,,,,,,,Other,145.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.87,145.13, EPIFIX 3.0 X 4.0 CM CONSIGN,Q4186,HCPCS,636,RC,,,,both,0.01,0.01,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.01,0.01, DRESSING EPIFIX 18MM DISC,Q4186,HCPCS,636,RC,,,,both,2282.72,1597.9,,,,,,,,,,,,,,,,,,,Other,492.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.87,492.16, EPIFIX 2.0x4.0 CM,Q4186,HCPCS,636,RC,,,,both,610.47,427.33,,,,,,,,,,,,,,,,,,,Other,131.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.87,131.61, PSN FEM PS CMT CRR NRW SZ7 R,C1776,HCPCS,278,RC,,,,both,6002.32,4201.62,,,,,,,,,,,,,,,,,,,Other,1294.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1294.1,1294.1, RESONATE ANTERIOR CERVICAL PLATE 2-LEVEL,L8699,HCPCS,278,RC,,,,both,3497.57,2448.3,,,,,,,,,,,,,,,,,,,Other,754.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,754.08,754.08, RESONATE ANTERIOR CERVICAL PLATE 2-LEVEL,L8699,HCPCS,278,RC,,,,both,3497.57,2448.3,,,,,,,,,,,,,,,,,,,Other,754.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,754.08,754.08, DRESSING EPIFIX 14MM DISC,Q4186,HCPCS,636,RC,,,,both,1075.59,752.91,,,,,,,,,,,,,,,,,,,Other,231.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.87,231.9, PSN ASF PS 13MM VE R 6-9 CD,C1776,HCPCS,278,RC,,,,both,2915.41,2040.79,,,,,,,,,,,,,,,,,,,Other,628.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,628.56,628.56, 6.5MM CANNULATED SCREW 16MM THD 90MM,C1713,HCPCS,272,RC,,,,both,721.08,504.76,,,,,,,,,,,,,,,,,,,Other,155.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,155.47,155.47, FLUID COLLECTION BAG,272,RC,,,,,,both,61.57,43.1,,,,,,,,,,,,,,,,,,,Other,13.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.28,13.28, DRILL BIT 3.2,272,RC,,,,,,both,184.57,129.2,,,,,,,,,,,,,,,,,,,Other,39.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.8,39.8, IMPACTOR TIP VERSA FX F/HIP,272,RC,,,,,,both,321.51,225.06,,,,,,,,,,,,,,,,,,,Other,69.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,69.32,69.32, TAP LAG SCREW,272,RC,,,,,,both,3979.29,2785.5,,,,,,,,,,,,,,,,,,,Other,857.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,857.93,857.93, DRILL BIT 1.7,278,RC,,,,,,both,1016.53,711.57,,,,,,,,,,,,,,,,,,,Other,219.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,219.17,219.17, HUMERAL STEM,278,RC,,,,,,both,8559.11,5991.38,,,,,,,,,,,,,,,,,,,Other,1845.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1845.34,1845.34, HUMERAL HEAD,278,RC,,,,,,both,6513.4,4559.38,,,,,,,,,,,,,,,,,,,Other,1404.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1404.29,1404.29, REPLICATOR PLATE TORQUE SCREW DRIVER,278,RC,,,,,,both,5372.96,3761.07,,,,,,,,,,,,,,,,,,,Other,1158.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1158.41,1158.41, HUMERAL STEM,278,RC,,,,,,both,11503.8,8052.66,,,,,,,,,,,,,,,,,,,Other,2480.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2480.22,2480.22, HUMERAL ADAPTER TRAY,278,RC,,,,,,both,7924.24,5546.97,,,,,,,,,,,,,,,,,,,Other,1708.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1708.46,1708.46, GLENOID PLATE,278,RC,,,,,,both,6583.94,4608.76,,,,,,,,,,,,,,,,,,,Other,1419.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1419.5,1419.5, GLENOSPHERE,278,RC,,,,,,both,8790.64,6153.45,,,,,,,,,,,,,,,,,,,Other,1895.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1895.26,1895.26, HUMERAL LINER,278,RC,,,,,,both,5010.3,3507.21,,,,,,,,,,,,,,,,,,,Other,1080.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1080.22,1080.22, TORQUE DEFINING SCREW,278,RC,,,,,,both,1093.4,765.38,,,,,,,,,,,,,,,,,,,Other,235.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,235.74,235.74, DRILL BITS,272,RC,,,,,,both,1316.78,921.75,,,,,,,,,,,,,,,,,,,Other,283.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,283.9,283.9, GLENOSPHERE LOCKING SCREW,278,RC,,,,,,both,505.54,353.88,,,,,,,,,,,,,,,,,,,Other,109,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,109,109, COMPRESSION SCREW/LOCKING CAP KIT,278,RC,,,,,,both,723.51,506.46,,,,,,,,,,,,,,,,,,,Other,155.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,155.99,155.99, COMPRESSION SCREW/LOCKING CAP KIT,278,RC,,,,,,both,723.51,506.46,,,,,,,,,,,,,,,,,,,Other,155.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,155.99,155.99, COMPRESSION SCREW/LOCKING CAP KIT,278,RC,,,,,,both,723.51,506.46,,,,,,,,,,,,,,,,,,,Other,155.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,155.99,155.99, COMPRESSION SCREW/LOCKING CAP KIT,278,RC,,,,,,both,505.54,353.88,,,,,,,,,,,,,,,,,,,Other,109,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,109,109, COMPRESSION SCREW/LOCKING CAP KIT,278,RC,,,,,,both,505.54,353.88,,,,,,,,,,,,,,,,,,,Other,109,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,109,109, COMPRESSION SCREW/LOCKING CAP KIT,278,RC,,,,,,both,505.54,353.88,,,,,,,,,,,,,,,,,,,Other,109,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,109,109, HUMERAL STEM,278,RC,,,,,,both,7994.78,5596.35,,,,,,,,,,,,,,,,,,,Other,1723.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1723.67,1723.67, GLENOSPHERE,278,RC,,,,,,both,6113.66,4279.56,,,,,,,,,,,,,,,,,,,Other,1318.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1318.11,1318.11, HUMERAL LINER,278,RC,,,,,,both,3480.08,2436.06,,,,,,,,,,,,,,,,,,,Other,750.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,750.31,750.31, 3.5MM CORTICAL SCREW SELF-TAP SMALL HEX,C1713,HCPCS,278,RC,,,,both,106.2,74.34,,,,,,,,,,,,,,,,,,,Other,22.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.89,22.89, 3.5MM ULS T-PLT 4H HEAD 6H SHAFT 85MM,C1713,HCPCS,278,RC,,,,both,1439.56,1007.69,,,,,,,,,,,,,,,,,,,Other,310.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,310.37,310.37, 5CC BETA-BSM KIT,C1713,HCPCS,278,RC,,,,both,4888.17,3421.72,,,,,,,,,,,,,,,,,,,Other,1053.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1053.89,1053.89, VENOUS OUTFLOW COMPONENT,278,RC,,,,,,both,8338.45,5836.92,,,,,,,,,,,,,,,,,,,Other,1797.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1797.77,1797.77, ARTERIAL GRAFT COMPONENT,278,RC,,,,,,both,3653.72,2557.6,,,,,,,,,,,,,,,,,,,Other,787.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,787.74,787.74, ACCESSORY COMPONENT KIT,278,RC,,,,,,both,1844.95,1291.47,,,,,,,,,,,,,,,,,,,Other,397.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,397.77,397.77, "VIATRAC 14 PLUS 4X20, 135CM",272,RC,,,,,,both,1067.18,747.03,,,,,,,,,,,,,,,,,,,Other,230.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,230.08,230.08, EMBOSHIELD NAV PROTECT SYSTEM,C1884,HCPCS,278,RC,,,,both,5813.6,4069.52,,,,,,,,,,,,,,,,,,,Other,1253.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1253.41,1253.41, STENT XACT 8-6X30,278,RC,,,,,,both,8844.9,6191.43,,,,,,,,,,,,,,,,,,,Other,1906.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1906.96,1906.96, "VIATRAC 14 PLUS 4X30, 135CM",272,RC,,,,,,both,1067.18,747.03,,,,,,,,,,,,,,,,,,,Other,230.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,230.08,230.08, "VIATRAC 14 PLUS 6X30, 135CM",272,RC,,,,,,both,1067.18,747.03,,,,,,,,,,,,,,,,,,,Other,230.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,230.08,230.08, STENT XACT 10-8MMX40MM,278,RC,,,,,,both,8844.9,6191.43,,,,,,,,,,,,,,,,,,,Other,1906.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1906.96,1906.96, "VIATRAC 14 PLUS 5X30, 135CM",272,RC,,,,,,both,1067.18,747.03,,,,,,,,,,,,,,,,,,,Other,230.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,230.08,230.08, PT CHARGE DRILL BIT 2.0,272,RC,,,,,,both,332.97,233.08,,,,,,,,,,,,,,,,,,,Other,71.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.78,71.78, CROWN CUP CLUSTER HOLE SHELL,278,RC,,,,,,both,8180.53,5726.37,,,,,,,,,,,,,,,,,,,Other,1763.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1763.73,1763.73, CROWN CUP GXL LINER,278,RC,,,,,,both,7042.45,4929.72,,,,,,,,,,,,,,,,,,,Other,1518.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1518.35,1518.35, FEMORAL STEM ELEMENT,278,RC,,,,,,both,20290.28,14203.2,,,,,,,,,,,,,,,,,,,Other,4374.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4374.58,4374.58, FEMORAL HEAD COCR 28MM DIA 3MM NK,278,RC,,,,,,both,1457.71,1020.4,,,,,,,,,,,,,,,,,,,Other,314.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,314.29,314.29, FEMORAL HEAD COCR,278,RC,,,,,,both,4773.36,3341.35,,,,,,,,,,,,,,,,,,,Other,1029.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1029.14,1029.14, FEMORAL HEAD COCR,278,RC,,,,,,both,4773.36,3341.35,,,,,,,,,,,,,,,,,,,Other,1029.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1029.14,1029.14, APLIGRAPH PER SQ CM,Q4101,HCPCS,636,RC,,,,both,4793.24,3355.27,,,,,,,,,,,,,,,,,,,Other,1033.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.87,1033.42, BB-TAK,C1713,HCPCS,278,RC,,,,both,183.15,128.21,,,,,,,,,,,,,,,,,,,Other,39.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.48,39.48, "BB-TAK, THREADED",C1713,HCPCS,278,RC,,,,both,291.55,204.09,,,,,,,,,,,,,,,,,,,Other,62.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,62.86,62.86, "LO-PRO SCRW,TI,3.0MMX 14MMCORT",C1713,HCPCS,278,RC,,,,both,386.71,270.7,,,,,,,,,,,,,,,,,,,Other,83.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,83.38,83.38, "LO-PRO SCRW,TI,3.0MMX 16MMCORT",C1713,HCPCS,278,RC,,,,both,386.71,270.7,,,,,,,,,,,,,,,,,,,Other,83.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,83.38,83.38, "LO-PRO SCRW,TI,3.0MMX 18MMCORT",C1713,HCPCS,278,RC,,,,both,386.71,270.7,,,,,,,,,,,,,,,,,,,Other,83.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,83.38,83.38, "CANNULATED DRILL BIT, 2.0MM (AO)",272,RC,,,,,,both,194.86,136.4,,,,,,,,,,,,,,,,,,,Other,42.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.01,42.01, "LO-PRO SCRW,TI,3X 28MMCANN,PT THD",C1713,HCPCS,278,RC,,,,both,421.87,295.31,,,,,,,,,,,,,,,,,,,Other,90.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,90.95,90.95, "GUIDEWIRE, .045""X5.91""",C1769,HCPCS,278,RC,,,,both,30.3,21.21,,,,,,,,,,,,,,,,,,,Other,6.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.54,6.54, "LO-PRO LOCK SCRW,TI3.0MMX 14MM",C1713,HCPCS,272,RC,,,,both,485.15,339.61,,,,,,,,,,,,,,,,,,,Other,104.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,104.6,104.6, "LO-PRO LOCK SCRW,TI,3.0MMX 16M",C1713,HCPCS,278,RC,,,,both,386.71,270.7,,,,,,,,,,,,,,,,,,,Other,83.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,83.38,83.38, ".062"" GUIDE WIRE WITH TROCAR TIP",C1769,HCPCS,278,RC,,,,both,63.34,44.34,,,,,,,,,,,,,,,,,,,Other,13.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.65,13.65, "DRILL BIT, 2.0MM (AO)",272,RC,,,,,,both,307.5,215.25,,,,,,,,,,,,,,,,,,,Other,66.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,66.3,66.3, "LO-PRO MTP PLT TM CONTRD,SHT,L,TI",C1713,HCPCS,278,RC,,,,both,2812.48,1968.74,,,,,,,,,,,,,,,,,,,Other,606.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,606.38,606.38, SPEEDBRG IMP SYS W/BIO-COMP SWVLK,C1713,HCPCS,278,RC,,,,both,5967.93,4177.55,,,,,,,,,,,,,,,,,,,Other,1286.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1286.68,1286.68, CANNULATED DRILL 3.5MM,A4649,HCPCS,272,RC,,,,both,633.07,443.15,,,,,,,,,,,,,,,,,,,Other,136.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,136.49,136.49, BONE TAP 4.5MM CANNULATED,A4649,HCPCS,272,RC,,,,both,633.07,443.15,,,,,,,,,,,,,,,,,,,Other,136.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,136.49,136.49, BONE TAP 5.5MM CANNULATED,A4649,HCPCS,272,RC,,,,both,633.07,443.15,,,,,,,,,,,,,,,,,,,Other,136.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,136.49,136.49, BONE TAP 6.0MM,A4649,HCPCS,272,RC,,,,both,633.07,443.15,,,,,,,,,,,,,,,,,,,Other,136.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,136.49,136.49, GUIDEWIRE W/TRCR TIP 2MMX200MM,A4649,HCPCS,272,RC,,,,both,633.07,443.15,,,,,,,,,,,,,,,,,,,Other,136.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,136.49,136.49, "LO-PRO SCRW,TI,5.5MMX45MM",C1713,HCPCS,278,RC,,,,both,2794.89,1956.42,,,,,,,,,,,,,,,,,,,Other,602.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,602.58,602.58, LO-PRO SCREW TI 3.0MMX20CORT,C1713,HCPCS,278,RC,,,,both,377.28,264.1,,,,,,,,,,,,,,,,,,,Other,81.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.34,81.34, "LO-PRO SCRW,TI,3.0MMX 22MMCORT",C1713,HCPCS,278,RC,,,,both,386.71,270.7,,,,,,,,,,,,,,,,,,,Other,83.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,83.38,83.38, 3.0X12MM VAL SCREW TI,C1713,HCPCS,278,RC,,,,both,480.18,336.13,,,,,,,,,,,,,,,,,,,Other,103.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,103.53,103.53, 3.0X14MM VAL SCREW TI,C1713,HCPCS,278,RC,,,,both,480.18,336.13,,,,,,,,,,,,,,,,,,,Other,103.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,103.53,103.53, 3.0X20MM VAL SCREW TI,C1713,HCPCS,278,RC,,,,both,480.18,336.13,,,,,,,,,,,,,,,,,,,Other,103.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,103.53,103.53, "LO-PRO MTP PLATE STR, LONG TI",C1713,HCPCS,278,RC,,,,both,2812.48,1968.74,,,,,,,,,,,,,,,,,,,Other,606.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,606.38,606.38, PHALANGEAL REAMER 22MM,C1713,HCPCS,278,RC,,,,both,1543.43,1080.4,,,,,,,,,,,,,,,,,,,Other,332.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,332.76,332.76, METATARSAL REAMER 22MM,C1713,HCPCS,278,RC,,,,both,1543.43,1080.4,,,,,,,,,,,,,,,,,,,Other,332.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,332.76,332.76, DECELLULARIZED DERMIS,278,RC,,,,,,both,32840.1,22988.07,,,,,,,,,,,,,,,,,,,Other,7080.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7080.32,7080.32, SPEEDBRG IMP SYS W/BIO-COMP SWVLK,C1713,HCPCS,278,RC,,,,both,6996.33,4897.43,,,,,,,,,,,,,,,,,,,Other,1508.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1508.41,1508.41, FHL IMPLANT SYSTEM 6.25 MM,C1713,HCPCS,278,RC,,,,both,5476.19,3833.33,,,,,,,,,,,,,,,,,,,Other,1180.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1180.66,1180.66, TENO SCREW KIT DISP.,C1713,HCPCS,278,RC,,,,both,668.83,468.18,,,,,,,,,,,,,,,,,,,Other,144.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,144.2,144.2, COMPR FT SCREW MINI 3.5 X 32MM,C1713,HCPCS,278,RC,,,,both,1200.46,840.32,,,,,,,,,,,,,,,,,,,Other,258.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,258.82,258.82, COMPR FT SCREW MINI 3.5 X 34MM,C1713,HCPCS,278,RC,,,,both,1200.46,840.32,,,,,,,,,,,,,,,,,,,Other,258.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,258.82,258.82, G-WIRE W/TRCR TIP .45 W/ LASER LINE,A4649,HCPCS,272,RC,,,,both,65.18,45.63,,,,,,,,,,,,,,,,,,,Other,14.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.05,14.05, DRILL BIT2.7MM CMP FT CALIBRATED,272,RC,,,,,,both,688.23,481.76,,,,,,,,,,,,,,,,,,,Other,148.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,148.38,148.38, DRILL PROFILE MINI CMP FT,A4649,HCPCS,272,RC,,,,both,529.41,370.59,,,,,,,,,,,,,,,,,,,Other,114.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,114.14,114.14, DRL BIT 5.0MM CANN,272,RC,,,,,,both,617.64,432.35,,,,,,,,,,,,,,,,,,,Other,133.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,133.16,133.16, COMPR FT SCRE XL 7 X 55MM,C1713,HCPCS,278,RC,,,,both,2383.78,1668.65,,,,,,,,,,,,,,,,,,,Other,513.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,513.94,513.94, COMPR FT SCREW XL 7 X 60MM,C1713,HCPCS,278,RC,,,,both,2383.78,1668.65,,,,,,,,,,,,,,,,,,,Other,513.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,513.94,513.94, GUIDEWIRE W/TRCR TIP 2.4MMX9.25,A4649,HCPCS,272,RC,,,,both,65.18,45.63,,,,,,,,,,,,,,,,,,,Other,14.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.05,14.05, GUIDEWIRE W/TRCR TIP 2.4MMX9.25,A4649,HCPCS,272,RC,,,,both,130.37,91.26,,,,,,,,,,,,,,,,,,,Other,28.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28.11,28.11, MAIN PUMP TUBING,278,RC,,,,,,both,220.76,154.53,,,,,,,,,,,,,,,,,,,Other,47.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.6,47.6, MULTIFIRE SCORPION NEEDLE,272,RC,,,,,,both,614.98,430.49,,,,,,,,,,,,,,,,,,,Other,132.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,132.59,132.59, SUTURE ANCH BIOCOMP SWI-VELOCK C CLD 4.7,272,RC,,,,,,both,1447.02,1012.91,,,,,,,,,,,,,,,,,,,Other,311.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,311.97,311.97, CANNULA TWIST-IN NOTCHED,C1713,HCPCS,278,RC,,,,both,111.35,77.95,,,,,,,,,,,,,,,,,,,Other,24.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.01,24.01, FIBERLINK,272,RC,,,,,,both,180.94,126.66,,,,,,,,,,,,,,,,,,,Other,39.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.01,39.01, BONE CUTTER 4.0MMX13CM,278,RC,,,,,,both,238.75,167.13,,,,,,,,,,,,,,,,,,,Other,51.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,51.48,51.48, FIBERTAPE,272,RC,,,,,,both,180.88,126.62,,,,,,,,,,,,,,,,,,,Other,38.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,38.99,38.99, SYNDESMOSIS TIGHTROPE XP IMPLANT STAINLE,C1713,HCPCS,278,RC,,,,both,5127.7,3589.39,,,,,,,,,,,,,,,,,,,Other,1105.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1105.53,1105.53, "FIBERWIRE #2 BLU 38"" W/2 STR DP NDL",272,RC,,,,,,both,195.98,137.19,,,,,,,,,,,,,,,,,,,Other,42.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.26,42.26, TORPEDO 4.0MMX13CM,278,RC,,,,,,both,365.37,255.76,,,,,,,,,,,,,,,,,,,Other,78.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,78.77,78.77, TAPERES CRVD NDL 26MM 1/2 CIRCLEX/LOOP,272,RC,,,,,,both,80.24,56.17,,,,,,,,,,,,,,,,,,,Other,17.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.3,17.3, "PUNCH, DISP CRKSCREW SWVLK ANCHS",272,RC,,,,,,both,271.31,189.92,,,,,,,,,,,,,,,,,,,Other,58.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,58.5,58.5, DBL LOADED 4.75MM BIO-COMP SWVLK,272,RC,,,,,,both,1508.55,1055.99,,,,,,,,,,,,,,,,,,,Other,325.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,325.24,325.24, "BIO-COMP SWIVELOCK C, FT, 4.75X19.1MM",272,RC,,,,,,both,1700.27,1190.19,,,,,,,,,,,,,,,,,,,Other,366.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,366.58,366.58, "BIO-COMP, SWIVELOCK C, TT, 4.75X19.1MM",272,RC,,,,,,both,1700.27,1190.19,,,,,,,,,,,,,,,,,,,Other,366.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,366.58,366.58, "IMPLANT SYS, BIOC ACHILLES SPEEEDB W JUM",C1713,HCPCS,278,RC,,,,both,7013.71,4909.6,,,,,,,,,,,,,,,,,,,Other,1512.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1512.16,1512.16, "IMPLANT SYS, BIOC ACHILLES SPEEDB W/JUMP",C1713,HCPCS,278,RC,,,,both,7307.69,5115.38,,,,,,,,,,,,,,,,,,,Other,1575.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1575.54,1575.54, UROLIFT UL400 DELIVERY DEVICE & IMPLANT,L8699,HCPCS,278,RC,,,,both,3344.15,2340.91,,,,,,,,,,,,,,,,,,,Other,721,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,721,721, "3.2MM THREAD PIN, 508MM",C1713,HCPCS,278,RC,,,,both,399.1,279.37,,,,,,,,,,,,,,,,,,,Other,86.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,86.04,86.04, CODA SHAVER 4.2MM,272,RC,,,,,,both,153.48,107.44,,,,,,,,,,,,,,,,,,,Other,33.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,33.09,33.09, SCREW COMPRESSION LAG,278,RC,,,,,,both,212.37,148.66,,,,,,,,,,,,,,,,,,,Other,45.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,45.79,45.79, FEMORAL NAIL,278,RC,,,,,,both,5468.77,3828.14,,,,,,,,,,,,,,,,,,,Other,1179.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1179.07,1179.07, LAG SCREW 80MM,C1713,HCPCS,278,RC,,,,both,2385.74,1670.02,,,,,,,,,,,,,,,,,,,Other,514.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,514.36,514.36, "3.2MM THREADED PIN, 450MM",272,RC,,,,,,both,661.35,462.95,,,,,,,,,,,,,,,,,,,Other,142.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,142.59,142.59, SCREW LAG 80MM 12.7 MM,278,RC,,,,,,both,994.07,695.85,,,,,,,,,,,,,,,,,,,Other,214.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,214.33,214.33, FEMORAL FIXATION 3 HOLE 135 DEGREE,278,RC,,,,,,both,1566.94,1096.86,,,,,,,,,,,,,,,,,,,Other,337.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,337.84,337.84, SCREW CORTICAL 4.5MM 40MM,278,RC,,,,,,both,69.97,48.98,,,,,,,,,,,,,,,,,,,Other,15.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.08,15.08, 3MMx100CM TEARDROP GD,C1713,HCPCS,278,RC,,,,both,597.75,418.43,,,,,,,,,,,,,,,,,,,Other,128.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,128.88,128.88, Z NAIL 10.5X95 LAG SCREW 75MM,278,RC,,,,,,both,1984.03,1388.82,,,,,,,,,,,,,,,,,,,Other,427.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,427.76,427.76, FEMORAL NAIL 10MMX21.5CM 130 R,C1776,HCPCS,278,RC,,,,both,4766.73,3336.71,,,,,,,,,,,,,,,,,,,Other,1027.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1027.71,1027.71, BIPOLAR LINER 53/54/55MM OD X 28MM ID,C1776,HCPCS,278,RC,,,,both,685.98,480.19,,,,,,,,,,,,,,,,,,,Other,147.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,147.9,147.9, BIPOLAR SHELL 55MM OD,C1776,HCPCS,278,RC,,,,both,9946.71,6962.7,,,,,,,,,,,,,,,,,,,Other,2144.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2144.51,2144.51, Z NAIL CPM 10MMX21.5CM 130L,C1713,HCPCS,278,RC,,,,both,5468.77,3828.14,,,,,,,,,,,,,,,,,,,Other,1179.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1179.07,1179.07, BALL TIP GUIDE WIRE 3.0MMX100CM,C1713,HCPCS,278,RC,,,,both,376.92,263.84,,,,,,,,,,,,,,,,,,,Other,81.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.26,81.26, LAG SCREW 10.5X90 Z NAIL,278,RC,,,,,,both,1729.93,1210.95,,,,,,,,,,,,,,,,,,,Other,372.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,372.97,372.97, BALL NOSE GUIDE WIRE 80CM,C1769,HCPCS,272,RC,,,,both,618.06,432.64,,,,,,,,,,,,,,,,,,,Other,133.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,133.25,133.25, PIN 2.0MM,C1713,HCPCS,278,RC,,,,both,343.4,240.38,,,,,,,,,,,,,,,,,,,Other,74.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,74.04,74.04, BALL NOSE GUIDE WIRE 100CM,C1769,HCPCS,272,RC,,,,both,506.26,354.38,,,,,,,,,,,,,,,,,,,Other,109.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,109.15,109.15, BIPOLAR SHELL 54MM OD,C1776,HCPCS,278,RC,,,,both,965.7,675.99,,,,,,,,,,,,,,,,,,,Other,208.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,208.2,208.2, VERSYS 6 INCH BEADED FC 11X160MM STD NEC,C1776,HCPCS,278,RC,,,,both,8554.65,5988.26,,,,,,,,,,,,,,,,,,,Other,1844.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1844.38,1844.38, M/L TAPER KINECTIV STEM SIZE 10,C1776,HCPCS,278,RC,,,,both,6711.18,4697.83,,,,,,,,,,,,,,,,,,,Other,1446.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1446.93,1446.93, 12/14 COCR FEMORAL HEAD 32MM + 0,C1776,HCPCS,278,RC,,,,both,1397.69,978.38,,,,,,,,,,,,,,,,,,,Other,301.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,301.34,301.34, CONTINUUM MULTI-HOLE SHELL 50 HH,C1776,HCPCS,278,RC,,,,both,9177.04,6423.93,,,,,,,,,,,,,,,,,,,Other,1978.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1978.57,1978.57, CONTINUUM VIVACIT-E NEUTRAL LINER HH 32x,C1776,HCPCS,278,RC,,,,both,3267.53,2287.27,,,,,,,,,,,,,,,,,,,Other,704.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,704.48,704.48, BIPOLAR SHEL 47MM OD,C1776,HCPCS,278,RC,,,,both,965.7,675.99,,,,,,,,,,,,,,,,,,,Other,208.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,208.2,208.2, MODULAR NECK 12/14 NECK TAPER,C1776,HCPCS,278,RC,,,,both,1269.06,888.34,,,,,,,,,,,,,,,,,,,Other,273.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,273.61,273.61, MODULAR NECK 12/14 TAPER,C1776,HCPCS,278,RC,,,,both,2435.63,1704.94,,,,,,,,,,,,,,,,,,,Other,525.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,525.12,525.12, MODULAR NEX C 12/14 NECK TAPER,C1776,HCPCS,278,RC,,,,both,1269.06,888.34,,,,,,,,,,,,,,,,,,,Other,273.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,273.61,273.61, BIPOLAR LINER 47/48/49MM OD X 28MM ID,C1776,HCPCS,278,RC,,,,both,685.98,480.19,,,,,,,,,,,,,,,,,,,Other,147.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,147.9,147.9, BIPOLAR SHELL 48MM OD,C1776,HCPCS,278,RC,,,,both,1131.66,792.16,,,,,,,,,,,,,,,,,,,Other,243.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,243.99,243.99, VERSYS PRESS FIT LD/FX SZ 11X120MM,C1776,HCPCS,278,RC,,,,both,4561.69,3193.18,,,,,,,,,,,,,,,,,,,Other,983.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,983.5,983.5, 12/14 COCE FEMORAL HEAD 28MM,C1776,HCPCS,278,RC,,,,both,1397.66,978.36,,,,,,,,,,,,,,,,,,,Other,301.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,301.34,301.34, MODULAR NECK E 12/14 TAPER,C1776,HCPCS,278,RC,,,,both,1269.06,888.34,,,,,,,,,,,,,,,,,,,Other,273.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,273.61,273.61, BIPOLAR SHELL 49MM OD,C1776,HCPCS,278,RC,,,,both,994.67,696.27,,,,,,,,,,,,,,,,,,,Other,214.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,214.45,214.45, VERSYS FM MC CLR 13X140MM STD NECK,C1776,HCPCS,278,RC,,,,both,12381.75,8667.23,,,,,,,,,,,,,,,,,,,Other,2669.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2669.51,2669.51, HIP PROSTHESIS TAPER 7.5,278,RC,,,,,,both,6909.75,4836.83,,,,,,,,,,,,,,,,,,,Other,1489.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1489.75,1489.75, HIP PROSTHESIS TAPER ML,C1776,HCPCS,278,RC,,,,both,7117.04,4981.93,,,,,,,,,,,,,,,,,,,Other,1534.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1534.44,1534.44, HIP PROSTHESIS TAPER 6,278,RC,,,,,,both,6909.75,4836.83,,,,,,,,,,,,,,,,,,,Other,1489.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1489.75,1489.75, HIP PROSTHESIS TAPER SZ 12.5,C1776,HCPCS,278,RC,,,,both,7117.04,4981.93,,,,,,,,,,,,,,,,,,,Other,1534.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1534.44,1534.44, MODULAR NEX G 12/14 NECK TAPER,C1776,HCPCS,278,RC,,,,both,1269.06,888.34,,,,,,,,,,,,,,,,,,,Other,273.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,273.61,273.61, "CONTINUUM LONGEVITY NEUTRAL LINER, MM 32",C1776,HCPCS,278,RC,,,,both,3267.48,2287.24,,,,,,,,,,,,,,,,,,,Other,704.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,704.47,704.47, CONTINUUM MULTI-HOLE SHELL 58LL,C1776,HCPCS,278,RC,,,,both,7545.78,5282.05,,,,,,,,,,,,,,,,,,,Other,1626.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1626.87,1626.87, VERSYS FM MC CLR 12X140MM STD NECK,C1776,HCPCS,278,RC,,,,both,12381.75,8667.23,,,,,,,,,,,,,,,,,,,Other,2669.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2669.51,2669.51, MODULAR NEX B 12/14 NECK TAPER,C1776,HCPCS,278,RC,,,,both,1269.06,888.34,,,,,,,,,,,,,,,,,,,Other,273.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,273.61,273.61, HIP PROSTHESIS TAPER SZ 16.25,C1776,HCPCS,278,RC,,,,both,6711.08,4697.76,,,,,,,,,,,,,,,,,,,Other,1446.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1446.91,1446.91, HEAD METASUL LDH 44 CODE J TAPER 18/20,278,RC,,,,,,both,6703.69,4692.58,,,,,,,,,,,,,,,,,,,Other,1445.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1445.31,1445.31, HEAD METASUL LDH 50 CODE P TAPER 18/20,278,RC,,,,,,both,7448.54,5213.98,,,,,,,,,,,,,,,,,,,Other,1605.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1605.91,1605.91, VERSYS ADVOCATE CEMENTED STEM 11X120 STA,C1776,HCPCS,278,RC,,,,both,5429.54,3800.68,,,,,,,,,,,,,,,,,,,Other,1170.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1170.61,1170.61, VERSYS DISTAL CENTRALIZER 11MM,C1776,HCPCS,278,RC,,,,both,183.15,128.21,,,,,,,,,,,,,,,,,,,Other,39.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.48,39.48, 12/14 COCR FEMORAL HEAD 36MM +7.0,C1776,HCPCS,278,RC,,,,both,2772.86,1941,,,,,,,,,,,,,,,,,,,Other,597.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,597.83,597.83, HIVAC 7 SINGLE/DOUBLE SINGLE,C1713,HCPCS,278,RC,,,,both,914.05,639.84,,,,,,,,,,,,,,,,,,,Other,197.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,197.07,197.07, BIPOLAR SHELL 53MM OD,C1776,HCPCS,278,RC,,,,both,1131.64,792.15,,,,,,,,,,,,,,,,,,,Other,243.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,243.98,243.98, VERSYS PRESS FIT LD/FX SZ 15X140MM,C1776,HCPCS,278,RC,,,,both,3080.14,2156.1,,,,,,,,,,,,,,,,,,,Other,664.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,664.08,664.08, HIP PROSTHESIS TAPER SZ 11,C1776,HCPCS,278,RC,,,,both,7117.04,4981.93,,,,,,,,,,,,,,,,,,,Other,1534.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1534.44,1534.44, 32MM MOD HEAD COCR STD NECK,C1776,HCPCS,278,RC,,,,both,1396.29,977.4,,,,,,,,,,,,,,,,,,,Other,301.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,301.04,301.04, ACETABULAR METASUL DUROM 50/044 CODE J,278,RC,,,,,,both,15497.58,10848.31,,,,,,,,,,,,,,,,,,,Other,3341.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3341.28,3341.28, ACETABULAR METASUL DUROM 56/050 CODE J,278,RC,,,,,,both,17219.52,12053.66,,,,,,,,,,,,,,,,,,,Other,3712.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3712.52,3712.52, ACETABULAR COMPONENT SIZE D 28MM,278,RC,,,,,,both,8682.12,6077.48,,,,,,,,,,,,,,,,,,,Other,1871.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1871.87,1871.87, ACETABULAR COMPONENT ELEV RM 28MM,278,RC,,,,,,both,8682.12,6077.48,,,,,,,,,,,,,,,,,,,Other,1871.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1871.87,1871.87, FEMORAL HEAD 28MM,278,RC,,,,,,both,4196.35,2937.45,,,,,,,,,,,,,,,,,,,Other,904.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,904.74,904.74, M/L TAPER KINECTIV STEM SIZE 9,C1776,HCPCS,278,RC,,,,both,7117.04,4981.93,,,,,,,,,,,,,,,,,,,Other,1534.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1534.44,1534.44, DISPOSABLE FLEXDRILL 15M,272,RC,,,,,,both,497.34,348.14,,,,,,,,,,,,,,,,,,,Other,107.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,107.22,107.22, MODULAR NEX R NECK TAPER,C1776,HCPCS,278,RC,,,,both,2435.63,1704.94,,,,,,,,,,,,,,,,,,,Other,525.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,525.12,525.12, MODULAR DRILL BIT 3.2X30,272,RC,,,,,,both,482.85,338,,,,,,,,,,,,,,,,,,,Other,104.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,104.11,104.11, ORTHOVISC 15 MG/ML SYG 2 ML,J7324,HCPCS,636,RC,,,,both,1543.99,1080.79,,,,,,,,,,,,,,,,,,,Other,332.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,109.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,109.03,332.89, HEAD ADAPTER METASUL TAPER 12/14-18/20,278,RC,,,,,,both,716.27,501.39,,,,,,,,,,,,,,,,,,,Other,154.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,154.43,154.43, DNO HIP PACK,272,RC,,,,,,both,904.39,633.07,,,,,,,,,,,,,,,,,,,Other,194.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,194.99,194.99, M/L TAPER KINECTIV STEM SIZE 13.5,C1776,HCPCS,278,RC,,,,both,7117.04,4981.93,,,,,,,,,,,,,,,,,,,Other,1534.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1534.44,1534.44, PSN ASF PS 10MM VE L 3-5 CD,C1776,HCPCS,278,RC,,,,both,3098.91,2169.24,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, PSN FEM PS CMT CCR NRW SZ4 L,C1776,HCPCS,278,RC,,,,both,6002.32,4201.62,,,,,,,,,,,,,,,,,,,Other,1294.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1294.1,1294.1, PSN FEM PS CMT CCR NRW SIZE 5 R,C1776,HCPCS,278,RC,,,,both,6954.74,4868.32,,,,,,,,,,,,,,,,,,,Other,1499.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1499.44,1499.44, PSN ASF PS 10MM VE R 3-5 CD,C1776,HCPCS,278,RC,,,,both,3098.91,2169.24,,,,,,,,,,,,,,,,,,,Other,668.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,668.12,668.12, PSN TIB STM 5 DEG SIZE D R,C1776,HCPCS,278,RC,,,,both,3349.98,2344.99,,,,,,,,,,,,,,,,,,,Other,722.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,722.26,722.26, 4 INCH INSERTION NEEDLE,272,RC,,,,,,both,484.4,339.08,,,,,,,,,,,,,,,,,,,Other,104.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,104.44,104.44, CABLE & SLEEVE SET 1.6MM,272,RC,,,,,,both,1548.31,1083.82,,,,,,,,,,,,,,,,,,,Other,333.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,333.82,333.82, "LEAD, NEUROSTIM TEST KIT",C1897,HCPCS,278,RC,,,,both,6859.8,4801.86,,,,,,,,,,,,,,,,,,,Other,1478.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1478.98,1478.98, NEUROSTIM PATIENT TRIAL KIT,272,RC,,,,,,both,301.9,211.33,,,,,,,,,,,,,,,,,,,Other,65.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,65.09,65.09, NEUROSTIM OR CABLE AND EXT,272,RC,,,,,,both,21.2,14.84,,,,,,,,,,,,,,,,,,,Other,4.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.57,4.57, NEUROSTIM ENHANCED KIT W/T STYLET CAP,272,RC,,,,,,both,415.06,290.54,,,,,,,,,,,,,,,,,,,Other,89.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,89.48,89.48, AFFIXUS HUMERAL PROX HUMEROUS LEFT LONG,C1713,HCPCS,278,RC,,,,both,7490.9,5243.63,,,,,,,,,,,,,,,,,,,Other,1615.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1615.04,1615.04, SCREW BLUNT TIP AFFIXUS BLUNT TIP SCREW,C1713,HCPCS,278,RC,,,,both,761.38,532.97,,,,,,,,,,,,,,,,,,,Other,164.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,164.15,164.15, ANN CORT BONE SCREW 4X24MM,C1713,HCPCS,278,RC,,,,both,737.58,516.31,,,,,,,,,,,,,,,,,,,Other,159.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,159.02,159.02, LO-PRO LOCK SCREW SS 2.7 X 16MM,C1713,HCPCS,278,RC,,,,both,421.25,294.88,,,,,,,,,,,,,,,,,,,Other,90.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,90.83,90.83, LO PRO LOCK SCRW SS 2.7X18MM,C1713,HCPCS,278,RC,,,,both,390.88,273.62,,,,,,,,,,,,,,,,,,,Other,84.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,84.27,84.27, G-WIRE W/TRCT TIP .078X5.91 IN(2MMX150MM,C1769,HCPCS,272,RC,,,,both,33.99,23.79,,,,,,,,,,,,,,,,,,,Other,7.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.33,7.33, LO PRO SCRW TM SS 3.5 X 14MMCORT,C1713,HCPCS,278,RC,,,,both,147.81,103.47,,,,,,,,,,,,,,,,,,,Other,31.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,31.87,31.87, LO PRO SCRW TM SS 3.5X16MMCORT,C1713,HCPCS,278,RC,,,,both,118.97,83.28,,,,,,,,,,,,,,,,,,,Other,25.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.65,25.65, LO PRO SCRW TM SS 3.5X24MMCORT,C1713,HCPCS,278,RC,,,,both,118.97,83.28,,,,,,,,,,,,,,,,,,,Other,25.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.65,25.65, LOP PRO SCRW TM SS 3.5X50MMCORT,C1713,HCPCS,278,RC,,,,both,157.85,110.5,,,,,,,,,,,,,,,,,,,Other,34.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.04,34.04, LO PRO SCRW TM SS 3.5X55MMCORT,C1713,HCPCS,278,RC,,,,both,118.97,83.28,,,,,,,,,,,,,,,,,,,Other,25.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.65,25.65, LOW PROF SCRW SS 4.0X50MMCAN LNG THD,C1713,HCPCS,278,RC,,,,both,604.4,423.08,,,,,,,,,,,,,,,,,,,Other,130.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,130.31,130.31, DRILL BIT 3.5 MM,272,RC,,,,,,both,270.96,189.67,,,,,,,,,,,,,,,,,,,Other,58.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,58.42,58.42, DRILL BIT Q-C 2.6MM DRILL BIT CANNULATED,272,RC,,,,,,both,612.08,428.46,,,,,,,,,,,,,,,,,,,Other,131.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,131.97,131.97, 2.0MM DRILL BIT CALIBRATED,272,RC,,,,,,both,347.99,243.59,,,,,,,,,,,,,,,,,,,Other,75.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,75.03,75.03, 2.5MM DRILL BIT,272,RC,,,,,,both,311.36,217.95,,,,,,,,,,,,,,,,,,,Other,67.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,67.13,67.13, 2.5 MM DRILL BIT CALIBRATED,272,RC,,,,,,both,291.54,204.08,,,,,,,,,,,,,,,,,,,Other,62.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,62.86,62.86, GUIDE WIRE TROCAR TIP 1.35MM,C1769,HCPCS,272,RC,,,,both,90.2,63.14,,,,,,,,,,,,,,,,,,,Other,19.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.44,19.44, PATIENT TRIAL KIT,272,RC,,,,,,both,293.4,205.38,,,,,,,,,,,,,,,,,,,Other,63.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,63.26,63.26, LOCK DISTAL FIBULA PLT SS RT 8H,C1713,HCPCS,278,RC,,,,both,2702.2,1891.54,,,,,,,,,,,,,,,,,,,Other,582.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,582.59,582.59, COMP PRIMARY STEM 7MM MINI,C1776,HCPCS,278,RC,,,,both,13580.52,9506.36,,,,,,,,,,,,,,,,,,,Other,2927.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2927.96,2927.96, Z NAIL10.5X120 LAG SCREW,C1713,HCPCS,278,RC,,,,both,1984.03,1388.82,,,,,,,,,,,,,,,,,,,Other,427.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,427.76,427.76, Z NAIL 5.0 X 35 CORT SCREW FA,C1713,HCPCS,278,RC,,,,both,712.21,498.55,,,,,,,,,,,,,,,,,,,Other,153.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,153.56,153.56, "CANNULA, TWIST-IN",C1713,HCPCS,278,RC,,,,both,88.23,61.76,,,,,,,,,,,,,,,,,,,Other,19.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.02,19.02, PROSTATE BX UROLOGY,272,RC,,,,,,both,1235.28,864.7,,,,,,,,,,,,,,,,,,,Other,266.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,266.32,266.32, PATHOLOGY KIT UROLOGY,272,RC,,,,,,both,91.26,63.88,,,,,,,,,,,,,,,,,,,Other,19.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.68,19.68, 16 CONTACT IMPLANTABLE PULSE GENERATOR K,C1820,HCPCS,278,RC,,,,both,72352.02,50646.41,,,,,,,,,,,,,,,,,,,Other,15599.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15599.09,15599.09, 35CM LONG TUNNELING TOOL,272,RC,,,,,,both,673.44,471.41,,,,,,,,,,,,,,,,,,,Other,145.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,145.2,145.2, PRECESION PASSING ELEVATOR,272,RC,,,,,,both,203.67,142.57,,,,,,,,,,,,,,,,,,,Other,43.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.91,43.91, M/L TAPER KINECTIV STEM SIZE 15,C1776,HCPCS,278,RC,,,,both,6905.81,4834.07,,,,,,,,,,,,,,,,,,,Other,1488.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1488.89,1488.89, "BIOLOX DELTA FEM HEAD, 36MM, +0MM",C1776,HCPCS,278,RC,,,,both,2486.68,1740.68,,,,,,,,,,,,,,,,,,,Other,536.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,536.13,536.13, CONTINUUM VIVACIT-E NEUTRAL LINER LL 36X,C1776,HCPCS,278,RC,,,,both,3086.91,2160.84,,,,,,,,,,,,,,,,,,,Other,665.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,665.54,665.54, STERLING BALLOON 3X40X150,C1725,HCPCS,272,RC,,,,both,651.68,456.18,,,,,,,,,,,,,,,,,,,Other,140.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,140.5,140.5, STERLING BALLON 4X40X135,C1725,HCPCS,272,RC,,,,both,651.68,456.18,,,,,,,,,,,,,,,,,,,Other,140.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,140.5,140.5, "SABLE SPACER, 10X22,6-12 MM, 8 DEG.",278,RC,,,,,,both,19980,13986,,,,,,,,,,,,,,,,,,,Other,4307.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4307.69,4307.69, VIABAHN BX BALLON EXP ENDO/6MMX39MM 7FR8,C1874,HCPCS,278,RC,,,,both,10828.19,7579.73,,,,,,,,,,,,,,,,,,,Other,2334.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2334.56,2334.56, "SABLE SPACER 10X26, 7-14MM, 15 DEGREE",278,RC,,,,,,both,19980,13986,,,,,,,,,,,,,,,,,,,Other,4307.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4307.69,4307.69, "SABLE SPACER 10X26, 9-16 MM, 8 DEGREE",C1889,HCPCS,278,RC,,,,both,19980,13986,,,,,,,,,,,,,,,,,,,Other,4307.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4307.69,4307.69, PSN TIB STM 5 DEG SZ H L,C1776,HCPCS,278,RC,,,,both,2997,2097.9,,,,,,,,,,,,,,,,,,,Other,646.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,646.15,646.15, CABLE READY PIN ASSY 4MMX 40MM,C1713,HCPCS,278,RC,,,,both,1889.21,1322.45,,,,,,,,,,,,,,,,,,,Other,407.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,407.32,407.32, PSN ASF PS 14MM VE R 10-12 GH,C1776,HCPCS,278,RC,,,,both,3008.65,2106.06,,,,,,,,,,,,,,,,,,,Other,648.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,648.66,648.66, ARCOS 15X175MM BRCH BODY STD,C1776,HCPCS,278,RC,,,,both,6909.75,4836.83,,,,,,,,,,,,,,,,,,,Other,1489.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1489.75,1489.75, RF CALIBRATED DRILL 4.3MM,271,RC,,,,,,both,382.78,267.95,,,,,,,,,,,,,,,,,,,Other,82.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,82.53,82.53, RF CALIBRATED DRILL 4.9MM,271,RC,,,,,,both,1457.04,1019.93,,,,,,,,,,,,,,,,,,,Other,314.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,314.14,314.14, Z NAIL 6.0X40 CANC SCREW FA,C1713,HCPCS,278,RC,,,,both,716.18,501.33,,,,,,,,,,,,,,,,,,,Other,154.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,154.41,154.41, "SABLE SPACER 10X26, 7-14MM, 15 DEGREE",C1889,HCPCS,278,RC,,,,both,21436.88,15005.82,,,,,,,,,,,,,,,,,,,Other,4621.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4621.79,4621.79, Z NAIL 6.0X70 CANC SCREW FA,C1713,HCPCS,278,RC,,,,both,716.18,501.33,,,,,,,,,,,,,,,,,,,Other,154.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,154.41,154.41, Z NAIL 6.0X85 CANC SCREW FA,C1713,HCPCS,278,RC,,,,both,716.18,501.33,,,,,,,,,,,,,,,,,,,Other,154.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,154.41,154.41, Z NAIL RF 11.5MMX20CM UNIV,C1776,HCPCS,278,RC,,,,both,7532.06,5272.44,,,,,,,,,,,,,,,,,,,Other,1623.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1623.91,1623.91, NCB CORT SCREW 5.0X 14MM SELF TAPPING,C1713,HCPCS,278,RC,,,,both,580.35,406.25,,,,,,,,,,,,,,,,,,,Other,125.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,125.13,125.13, PSN FEM PS CMT CCR NRW SZ9 L,C1776,HCPCS,278,RC,,,,both,5827.5,4079.25,,,,,,,,,,,,,,,,,,,Other,1256.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1256.41,1256.41, PSN ASF PS 13MM VE L 6-9 EF,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, BIOLOAR SHELL 44MM OD,C1776,HCPCS,278,RC,,,,both,1098.7,769.09,,,,,,,,,,,,,,,,,,,Other,236.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,236.88,236.88, BIPOLAR LINER 44/45/46MM OD X 28MM ID,C1776,HCPCS,278,RC,,,,both,666,466.2,,,,,,,,,,,,,,,,,,,Other,143.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,143.59,143.59, PSN FEM PS CMT CRR NRW SZ8 L,C1776,HCPCS,278,RC,,,,both,5827.5,4079.25,,,,,,,,,,,,,,,,,,,Other,1256.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1256.41,1256.41, STENT EXPRESS LD ILIAC BIL OTW 5MMX17MM,C1874,HCPCS,278,RC,,,,both,3837.99,2686.59,,,,,,,,,,,,,,,,,,,Other,827.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,827.47,827.47, PSN FEM PS CMT CCR STD SZ9 L,C1776,HCPCS,278,RC,,,,both,5827.5,4079.25,,,,,,,,,,,,,,,,,,,Other,1256.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1256.41,1256.41, PSN ASF PS 12MM VE R 6-9 GH,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, "INDEPENDENCE MIS SPACER, 24X30MM 15DEG",C1889,HCPCS,278,RC,,,,both,27439.2,19207.44,,,,,,,,,,,,,,,,,,,Other,5915.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5915.89,5915.89, "LUMBAR ANCHOR, 25MM",C1713,HCPCS,278,RC,,,,both,1665,1165.5,,,,,,,,,,,,,,,,,,,Other,358.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,358.97,358.97, PSN ASF PS 12MM VE L 6-9 GH,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, PSN ASF PS 12MM VE L 3-5 CD,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, "DNO INSULATED EXTENSION BLADE HEX6""",272,RC,,,,,,both,25.54,17.88,,,,,,,,,,,,,,,,,,,Other,5.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.51,5.51, COATED STRAIGHT LAP ELECTORDE 36CM,272,RC,,,,,,both,144.69,101.28,,,,,,,,,,,,,,,,,,,Other,31.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,31.19,31.19, PACK SPINE CUSTOM,272,RC,,,,,,both,318.08,222.66,,,,,,,,,,,,,,,,,,,Other,68.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.58,68.58, DNO PACK MINOR SETUP TRAY,272,RC,,,,,,both,169.66,118.76,,,,,,,,,,,,,,,,,,,Other,36.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.58,36.58, LOCKING SCREW 2.7 X 10MM,C1713,HCPCS,278,RC,,,,both,1461.87,1023.31,,,,,,,,,,,,,,,,,,,Other,315.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,315.18,315.18, LOCKING SCREW 2.7X12MM,C1713,HCPCS,278,RC,,,,both,1461.87,1023.31,,,,,,,,,,,,,,,,,,,Other,315.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,315.18,315.18, DRILL BIT 2.5 X 30MM,C1713,HCPCS,278,RC,,,,both,1165.5,815.85,,,,,,,,,,,,,,,,,,,Other,251.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,251.28,251.28, K-WIRE 1.4X150MM BLUNT/TROCAR,C1713,HCPCS,278,RC,,,,both,179.82,125.87,,,,,,,,,,,,,,,,,,,Other,38.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,38.77,38.77, MTP PLATE LEFT,C1713,HCPCS,278,RC,,,,both,12311.01,8617.71,,,,,,,,,,,,,,,,,,,Other,2654.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2654.25,2654.25, SCREW LAG 3.5 X 18MM,C1713,HCPCS,278,RC,,,,both,1658.34,1160.84,,,,,,,,,,,,,,,,,,,Other,357.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,357.53,357.53, LO-PRO LOCK SCREW SS 2.7X18MM,C1713,HCPCS,278,RC,,,,both,382.95,268.07,,,,,,,,,,,,,,,,,,,Other,82.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,82.56,82.56, CACELLOUS SCREW 3.0 X 18MM,C1713,HCPCS,278,RC,,,,both,143.5,100.45,,,,,,,,,,,,,,,,,,,Other,30.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,30.94,30.94, LO PRO SCRW TM SS 3.5 X 18MMCORT,C1713,HCPCS,278,RC,,,,both,143.5,100.45,,,,,,,,,,,,,,,,,,,Other,30.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,30.94,30.94, LO PRO SCRW TM SS 3.5 X 26MMCORT,C1713,HCPCS,278,RC,,,,both,143.5,100.45,,,,,,,,,,,,,,,,,,,Other,30.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,30.94,30.94, 5 HOLE LOCKING DISTAL FIB PLATE R,C1713,HCPCS,278,RC,,,,both,2414.25,1689.98,,,,,,,,,,,,,,,,,,,Other,520.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,520.52,520.52, DISTRACTION PIN 12MM,C1713,HCPCS,278,RC,,,,both,233.1,163.17,,,,,,,,,,,,,,,,,,,Other,50.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.25,50.25, AFB1115-AVAFLEXBALLOON 10G 15MM,C1889,HCPCS,278,RC,,,,both,8576.42,6003.49,,,,,,,,,,,,,,,,,,,Other,1849.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1849.07,1849.07, "NIKO SPACER 14X16, 3.5/3.5 DEG, 21MM",C1889,HCPCS,278,RC,,,,both,13320,9324,,,,,,,,,,,,,,,,,,,Other,2871.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2871.79,2871.79, 2-0 FW BLUE W/TPR 3/8CIR NEEDLE,272,RC,,,,,,both,90.2,63.14,,,,,,,,,,,,,,,,,,,Other,19.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.44,19.44, "DUAL-FLEX GUIDEWIRE .035""X150CM, ANGLED",272,RC,,,,,,both,175.88,123.12,,,,,,,,,,,,,,,,,,,Other,37.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.92,37.92, PSN TIB STM 5 DEG SIZE C R,C1776,HCPCS,278,RC,,,,both,2997,2097.9,,,,,,,,,,,,,,,,,,,Other,646.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,646.15,646.15, PSN ASF PS 16MM VE R 3-5 CD,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, ASSURITY PACEMAKER MRI,C1785,HCPCS,275,RC,,,,both,14652,10256.4,,,,,,,,,,,,,,,,,,,Other,3158.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3158.97,3158.97, "US STR POUCH ASSY, LEAD CAP",272,RC,,,,,,both,149.85,104.9,,,,,,,,,,,,,,,,,,,Other,32.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.31,32.31, RESONATE ANTERIOR CERVICAL PLATE 2-LEVEL,L8699,HCPCS,278,RC,,,,both,3300,2310,,,,,,,,,,,,,,,,,,,Other,711.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,711.48,711.48, PSN ASF PS 12MM VE R 10-11 EF,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, MOBI-C CERVICAL DISC PROSTHESIS 13 X 15,L8699,HCPCS,278,RC,,,,both,14851.8,10396.26,,,,,,,,,,,,,,,,,,,Other,3202.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3202.05,3202.05, DYNJS0164 MINOR SET UP PACK,272,RC,,,,,,both,189.05,132.34,,,,,,,,,,,,,,,,,,,Other,40.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.76,40.76, 1200 PSI TUBING,272,RC,,,,,,both,29.56,20.69,,,,,,,,,,,,,,,,,,,Other,6.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.37,6.37, SURSEAL ENDOSCOPIC VALVE,272,RC,,,,,,both,59.45,41.62,,,,,,,,,,,,,,,,,,,Other,12.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.82,12.82, PSN MC VE ASF PS L 13MM VE 10-12 GH,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, "HEDRON P SPACER 10X26, 8MM 8 DEG",C1889,HCPCS,278,RC,,,,both,14152.5,9906.75,,,,,,,,,,,,,,,,,,,Other,3051.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3051.28,3051.28, PSN ASF PS 11MM VE L 3-5 EF,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, ANNULOTOMY KNIFE,272,RC,,,,,,both,832.5,582.75,,,,,,,,,,,,,,,,,,,Other,179.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,179.49,179.49, "INDEPENDENCE MIS SPACER, 24X30MM 15DEG 1",C1889,HCPCS,278,RC,,,,both,27439.2,19207.44,,,,,,,,,,,,,,,,,,,Other,5915.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5915.89,5915.89, K-WIRES,272,RC,,,,,,both,499.5,349.65,,,,,,,,,,,,,,,,,,,Other,107.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,107.69,107.69, BIPOLAR FORCEPS BAYON.STRAIGHT,272,RC,,,,,,both,2664,1864.8,,,,,,,,,,,,,,,,,,,Other,574.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,574.36,574.36, ILLUMINATION SYSTEM,C1713,HCPCS,278,RC,,,,both,8271.72,5790.2,,,,,,,,,,,,,,,,,,,Other,1783.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1783.38,1783.38, "RISE SPACER, 18X50MM, 7-14MM, 3-15 DEGRE",C1889,HCPCS,278,RC,,,,both,27439.2,19207.44,,,,,,,,,,,,,,,,,,,Other,5915.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5915.89,5915.89, "DNO .35"" SIMMONS 1 CATH 4 FR. 65CM",272,RC,,,,,,both,49.2,34.44,,,,,,,,,,,,,,,,,,,Other,10.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.6,10.6, PSN MC VE ASF L 16MM 6-9 GH,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, MINIONE BUTTON 24FR SIZE 2.5 CM,272,RC,,,,,,both,439.56,307.69,,,,,,,,,,,,,,,,,,,Other,94.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,94.77,94.77, MINIONE BUTTON 24FR SIZE 3.0CM,272,RC,,,,,,both,439.56,307.69,,,,,,,,,,,,,,,,,,,Other,94.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,94.77,94.77, MINIONE BUTTON 24FR SIZE 3.5CM,272,RC,,,,,,both,439.56,307.69,,,,,,,,,,,,,,,,,,,Other,94.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,94.77,94.77, "SABLE SPACER, 10X30,6-12 MM, 8 DEG.",C1889,HCPCS,278,RC,,,,both,19980,13986,,,,,,,,,,,,,,,,,,,Other,4307.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4307.69,4307.69, "ELSA SPACER 20 X 55MM, 8-17MM, 5-20 DEG.",C1889,HCPCS,278,RC,,,,both,35842.46,25089.72,,,,,,,,,,,,,,,,,,,Other,7727.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7727.63,7727.63, "SELF DRILLING SCREW, VARIABLE ANGLE 5.5M",C1713,HCPCS,278,RC,,,,both,1485.18,1039.63,,,,,,,,,,,,,,,,,,,Other,320.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,320.21,320.21, "K-WIRES, THREADED, BLUNT",272,RC,,,,,,both,522.81,365.97,,,,,,,,,,,,,,,,,,,Other,112.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,112.72,112.72, LUTONIX 018 4X80 4F,C1725,HCPCS,278,RC,,,,both,6516.81,4561.77,,,,,,,,,,,,,,,,,,,Other,1405.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1405.03,1405.03, STERLING BALLON 3X20X150,C1725,HCPCS,272,RC,,,,both,632.7,442.89,,,,,,,,,,,,,,,,,,,Other,136.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,136.41,136.41, 3.5MM SCREW HEX,C1713,HCPCS,278,RC,,,,both,732.6,512.82,,,,,,,,,,,,,,,,,,,Other,157.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,157.95,157.95, PSN ASF PS 13MM VE R 10-12 GH,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, SINGLE USE GRASPING FORCEPS,272,RC,,,,,,both,263.9,184.73,,,,,,,,,,,,,,,,,,,Other,56.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,56.9,56.9, CANNULATED COMPRESSION SCREW W/ S.S. 14M,C1713,HCPCS,278,RC,,,,both,1884.78,1319.35,,,,,,,,,,,,,,,,,,,Other,406.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,406.36,406.36, LOW PROFILE SCREW TI 4.5X24MM,C1713,HCPCS,278,RC,,,,both,249.75,174.83,,,,,,,,,,,,,,,,,,,Other,53.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,53.85,53.85, LOW PROFILE SCREW TI 4.5X26MM,C1713,HCPCS,278,RC,,,,both,249.75,174.83,,,,,,,,,,,,,,,,,,,Other,53.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,53.85,53.85, "ANKLE FUSION PLATE, ANT TT, RIGHT",C1713,HCPCS,278,RC,,,,both,6909.75,4836.83,,,,,,,,,,,,,,,,,,,Other,1489.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1489.75,1489.75, LOW PROFILE SCREW TI 4.5X34MM,C1713,HCPCS,278,RC,,,,both,249.75,174.83,,,,,,,,,,,,,,,,,,,Other,53.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,53.85,53.85, LOW PROFILE SCREW TI 4.5X46MM,C1713,HCPCS,278,RC,,,,both,999,699.3,,,,,,,,,,,,,,,,,,,Other,215.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,215.38,215.38, LOW PROFILE SCREW TI 4.5X50MM,C1713,HCPCS,278,RC,,,,both,249.75,174.83,,,,,,,,,,,,,,,,,,,Other,53.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,53.85,53.85, LOW PROFILE SCREW TI 4.5X55MM,C1713,HCPCS,278,RC,,,,both,249.75,174.83,,,,,,,,,,,,,,,,,,,Other,53.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,53.85,53.85, LOW PROFILE SCREW TI 4.5X30MM,C1713,HCPCS,278,RC,,,,both,649.35,454.55,,,,,,,,,,,,,,,,,,,Other,140,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,140,140, LOW PROFILE SCREW TI 5.5X50MM,C1713,HCPCS,278,RC,,,,both,249.75,174.83,,,,,,,,,,,,,,,,,,,Other,53.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,53.85,53.85, "PRFL DRL, 7.0MM CMPR FT",272,RC,,,,,,both,666,466.2,,,,,,,,,,,,,,,,,,,Other,143.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,143.59,143.59, ".062X7"" LONG, GUIDEWIRE",A4649,HCPCS,272,RC,,,,both,133.2,93.24,,,,,,,,,,,,,,,,,,,Other,28.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28.71,28.71, "LARGE BB-TAK, THREADED",C1713,HCPCS,278,RC,,,,both,499.5,349.65,,,,,,,,,,,,,,,,,,,Other,107.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,107.69,107.69, "CALIBRATED DRILL BIT, 3.0MM, LONG",272,RC,,,,,,both,649.35,454.55,,,,,,,,,,,,,,,,,,,Other,140,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,140,140, "SOLID DRILL BIT, 5.5MM LONG",272,RC,,,,,,both,499.5,349.65,,,,,,,,,,,,,,,,,,,Other,107.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,107.69,107.69, 1.65MM K-WIRE 600MM BLUNT THREAD,272,RC,,,,,,both,499.5,349.65,,,,,,,,,,,,,,,,,,,Other,107.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,107.69,107.69, DNO UMBILICAL CORD TAPE 1/8X36,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, FIBERGRAFT BG PUTTY XXS 1CC,C1713,HCPCS,278,RC,,,,both,715.95,501.17,,,,,,,,,,,,,,,,,,,Other,154.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,154.36,154.36, SKY 2 LEVEL PLTE 28MM T1,L8699,HCPCS,278,RC,,,,both,2497.5,1748.25,,,,,,,,,,,,,,,,,,,Other,538.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,538.46,538.46, SKY VARIABLE S-D SCREW 16MM T1,272,RC,,,,,,both,399.6,279.72,,,,,,,,,,,,,,,,,,,Other,86.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,86.15,86.15, DISTRACTOR PIN 12MM,C1713,HCPCS,278,RC,,,,both,274.63,192.24,,,,,,,,,,,,,,,,,,,Other,59.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,59.21,59.21, ACIS-STERILE LORDOTIC/STANDARD-5MM HT,L8699,HCPCS,278,RC,,,,both,2580.75,1806.53,,,,,,,,,,,,,,,,,,,Other,556.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,556.41,556.41, ACIS STERILE LORDOTIC/STANDARD-6MM HT,L8699,HCPCS,278,RC,,,,both,2580.75,1806.53,,,,,,,,,,,,,,,,,,,Other,556.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,556.41,556.41, ACIS STERILE LORDOTIC/STANDARD-7MM HT,L8699,HCPCS,278,RC,,,,both,2580.75,1806.53,,,,,,,,,,,,,,,,,,,Other,556.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,556.41,556.41, FIBERGRAFT BG PUTTY XXS 2CC,C1713,HCPCS,278,RC,,,,both,1435.9,1005.13,,,,,,,,,,,,,,,,,,,Other,309.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,309.58,309.58, SKY 1 LEVEL PLTE 12MM T1,L8699,HCPCS,278,RC,,,,both,2247.75,1573.43,,,,,,,,,,,,,,,,,,,Other,484.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,484.62,484.62, SKY VARIABLE S-D SCREW 18MM T1,272,RC,,,,,,both,399.6,279.72,,,,,,,,,,,,,,,,,,,Other,86.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,86.15,86.15, SKY VARIABLE S-D SCREW 16MM T1(52016),272,RC,,,,,,both,399.6,279.72,,,,,,,,,,,,,,,,,,,Other,86.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,86.15,86.15, "CONF INTRO NEEDLE, 11G 6""",C1713,HCPCS,278,RC,,,,both,529.47,370.63,,,,,,,,,,,,,,,,,,,Other,114.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,114.15,114.15, 1.6 MM KIRSCHER WIRE BLNT TIP 480MM,272,RC,,,,,,both,166.5,116.55,,,,,,,,,,,,,,,,,,,Other,35.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.9,35.9, 5.0 MM TI CAN MTRZ PLYAX 45MM SCREW,C1713,HCPCS,278,RC,,,,both,3113.55,2179.49,,,,,,,,,,,,,,,,,,,Other,671.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,671.28,671.28, 7.0 MM T1 CAN MTRX PLYAX SCRW 45MM,C1713,HCPCS,278,RC,,,,both,2997,2097.9,,,,,,,,,,,,,,,,,,,Other,646.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,646.15,646.15, FIBERGRAFT BG PUTTY GPD M 6CC,C1713,HCPCS,278,RC,,,,both,4279.05,2995.34,,,,,,,,,,,,,,,,,,,Other,922.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,922.56,922.56, 200 MM FIBERGRAFT GPS CANNULA,272,RC,,,,,,both,599.4,419.58,,,,,,,,,,,,,,,,,,,Other,129.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,129.23,129.23, VIPER 2 LORDOTIC ROD 40MM,C1776,HCPCS,278,RC,,,,both,566.1,396.27,,,,,,,,,,,,,,,,,,,Other,122.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,122.05,122.05, X-PAC 10X28MM LORDOTIC,C1776,HCPCS,278,RC,,,,both,17898.75,12529.13,,,,,,,,,,,,,,,,,,,Other,3858.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3858.98,3858.98, MATRIX LOCKING CAP W/O SADDLE,C1776,HCPCS,278,RC,,,,both,166.5,116.55,,,,,,,,,,,,,,,,,,,Other,35.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.9,35.9, FIBERGRAFT GPS CANNULA 100 MM,272,RC,,,,,,both,599.4,419.58,,,,,,,,,,,,,,,,,,,Other,129.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,129.23,129.23, 480MM FLX GUIDE WIRE W/ CONICAL TIP,A4649,HCPCS,272,RC,,,,both,166.5,116.55,,,,,,,,,,,,,,,,,,,Other,35.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.9,35.9, PSN ASF PS 10MM VE R 10-11 EF,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, CONTINUUM MULTI-HOLE SHELL 60MM,C1776,HCPCS,278,RC,,,,both,7326,5128.2,,,,,,,,,,,,,,,,,,,Other,1579.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1579.49,1579.49, CONTINUUM VIVACIT-E NEUTRAL LINER 36X60,C1776,HCPCS,278,RC,,,,both,2997,2097.9,,,,,,,,,,,,,,,,,,,Other,646.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,646.15,646.15, FIBERGRAFT BG PUTTY XXS 4CC,C1713,HCPCS,278,RC,,,,both,2814.35,1970.05,,,,,,,,,,,,,,,,,,,Other,606.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,606.78,606.78, PSN FEM PS CMT CCR STD SZ8 R,C1776,HCPCS,278,RC,,,,both,5827.5,4079.25,,,,,,,,,,,,,,,,,,,Other,1256.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1256.41,1256.41, PSN ASF CPS 14MM VE R 10-12 GH,C1776,HCPCS,278,RC,,,,both,3546.45,2482.52,,,,,,,,,,,,,,,,,,,Other,764.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,764.62,764.62, UMBILICAL TAPE 1/8x30 x 2,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, PEDICLE ACCESS TROCAR,C1713,HCPCS,278,RC,,,,both,10076.58,7053.61,,,,,,,,,,,,,,,,,,,Other,2172.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2172.51,2172.51, VIPER 2 LORDOTIC ROD 60MM,C1776,HCPCS,278,RC,,,,both,566.1,396.27,,,,,,,,,,,,,,,,,,,Other,122.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,122.05,122.05, "8MM,4DEG, 26/9 IBF",C1776,HCPCS,278,RC,,,,both,7659,5361.3,,,,,,,,,,,,,,,,,,,Other,1651.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1651.28,1651.28, VIPER 2 LORDOTIC ROD 65MM,C1776,HCPCS,278,RC,,,,both,799.2,559.44,,,,,,,,,,,,,,,,,,,Other,172.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,172.3,172.3, TI POLYAXIAL REDUCTION HEAD FOR TI MATRI,C1713,HCPCS,278,RC,,,,both,1665,1165.5,,,,,,,,,,,,,,,,,,,Other,358.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,358.97,358.97, PSN ASF PS 11MM VE L 6-9 EF,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, VIPER 2 LORDOTIC ROD 35MM,C1776,HCPCS,278,RC,,,,both,799.2,559.44,,,,,,,,,,,,,,,,,,,Other,172.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,172.3,172.3, "7MM,4DEG, 26/9 IBF",C1776,HCPCS,278,RC,,,,both,8741.25,6118.88,,,,,,,,,,,,,,,,,,,Other,1884.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1884.62,1884.62, VIPER 2 LORDOTIC ROD 45MM,C1776,HCPCS,278,RC,,,,both,566.1,396.27,,,,,,,,,,,,,,,,,,,Other,122.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,122.05,122.05, "10MM,4DEG, 26/9 IBF",C1776,HCPCS,278,RC,,,,both,7659,5361.3,,,,,,,,,,,,,,,,,,,Other,1651.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1651.28,1651.28, "CONTINUUM LONGEVITY NEUTRAL LINER, GG 28",C1776,HCPCS,278,RC,,,,both,2664,1864.8,,,,,,,,,,,,,,,,,,,Other,574.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,574.36,574.36, JGRLOC SS SLD DRL KIT,272,RC,,,,,,both,2471.03,1729.72,,,,,,,,,,,,,,,,,,,Other,532.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,532.76,532.76, PERI SCREW 3.5MM X 30MM W/2.7 HEAD,C1713,HCPCS,278,RC,,,,both,158.14,110.7,,,,,,,,,,,,,,,,,,,Other,34.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.09,34.09, SKY VARIABLE S-D SCREW 14MM T1,272,RC,,,,,,both,399.6,279.72,,,,,,,,,,,,,,,,,,,Other,86.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,86.15,86.15, SKY 2 LEVEL PLTE 26MM T1,L8699,HCPCS,278,RC,,,,both,2497.5,1748.25,,,,,,,,,,,,,,,,,,,Other,538.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,538.46,538.46, SKY 3 LEVEL PLTE 45MM T1,L8699,HCPCS,278,RC,,,,both,2664,1864.8,,,,,,,,,,,,,,,,,,,Other,574.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,574.36,574.36, LO-PRO LOCK SCREW SS 2.7 X 14MM,C1713,HCPCS,278,RC,,,,both,382.95,268.07,,,,,,,,,,,,,,,,,,,Other,82.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,82.56,82.56, LO PRO SCRW TM SS 3.5 X 22MMCORT,C1713,HCPCS,278,RC,,,,both,143.5,100.45,,,,,,,,,,,,,,,,,,,Other,30.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,30.94,30.94, LO PRO SCRW TM SS 3.5 X 35MMCORT,C1713,HCPCS,278,RC,,,,both,143.5,100.45,,,,,,,,,,,,,,,,,,,Other,30.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,30.94,30.94, LOW PROF SCRW SS 4.0X45MMCAN LNG THD,C1713,HCPCS,278,RC,,,,both,544.5,381.15,,,,,,,,,,,,,,,,,,,Other,117.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,117.39,117.39, 2.5MM DRILL BIT CALIBRATED,272,RC,,,,,,both,283.05,198.14,,,,,,,,,,,,,,,,,,,Other,61.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.02,61.02, LOCK DISTAL FIBULA PLT SS RT 6H,C1713,HCPCS,278,RC,,,,both,2664,1864.8,,,,,,,,,,,,,,,,,,,Other,574.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,574.36,574.36, "G-WIRE W/TRCR TIP .94""X8""",C1769,HCPCS,272,RC,,,,both,61.5,43.05,,,,,,,,,,,,,,,,,,,Other,13.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.26,13.26, CANNULATED DRILL BIT 4.0MM,272,RC,,,,,,both,649.35,454.55,,,,,,,,,,,,,,,,,,,Other,140,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,140,140, "LOW PRO SCREW TI 6.7X40MMCANN, 18MM THD",272,RC,,,,,,both,832.5,582.75,,,,,,,,,,,,,,,,,,,Other,179.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,179.49,179.49, HEMOSTATIC PEEL AWAY 9FRX 13CM SYSTEM,C1982,HCPCS,272,RC,,,,both,216.45,151.52,,,,,,,,,,,,,,,,,,,Other,46.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,46.67,46.67, SKY 3 LEVEL PLTE 48MM T1,L8699,HCPCS,278,RC,,,,both,2664,1864.8,,,,,,,,,,,,,,,,,,,Other,574.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,574.36,574.36, SKY 2 LEVEL PLTE 30MM T1,L8699,HCPCS,278,RC,,,,both,2497.5,1748.25,,,,,,,,,,,,,,,,,,,Other,538.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,538.46,538.46, VIPER 2 LORDOTIC ROD 70MM,C1776,HCPCS,278,RC,,,,both,799.2,559.44,,,,,,,,,,,,,,,,,,,Other,172.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,172.3,172.3, 7.0 MM T1 CAN MTRX PLYAX SCRW 50MM,C1713,HCPCS,278,RC,,,,both,2977,2083.9,,,,,,,,,,,,,,,,,,,Other,641.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,641.84,641.84, Z NAIL 5.0X47.5 CORT SCREW FA,C1713,HCPCS,278,RC,,,,both,620.81,434.57,,,,,,,,,,,,,,,,,,,Other,133.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,133.85,133.85, Z NAIL CPM 11.5MM X 38CM 130R,C1713,HCPCS,278,RC,,,,both,7976.58,5583.61,,,,,,,,,,,,,,,,,,,Other,1719.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1719.75,1719.75, "11MM,4DEG, 26/9 IBF",C1776,HCPCS,278,RC,,,,both,7659,5361.3,,,,,,,,,,,,,,,,,,,Other,1651.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1651.28,1651.28, ACIS STERILE LORDOTIC/STANDARD-8MM HT,C1889,HCPCS,278,RC,,,,both,2580.75,1806.53,,,,,,,,,,,,,,,,,,,Other,556.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,556.41,556.41, BONE SCREW 6.5X20 SELF TAP,C1713,HCPCS,278,RC,,,,both,233.1,163.17,,,,,,,,,,,,,,,,,,,Other,50.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.25,50.25, 8.0 MM T1 CAN MTRX PLYAX SCRW 50MM,C1713,HCPCS,278,RC,,,,both,3113.55,2179.49,,,,,,,,,,,,,,,,,,,Other,671.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,671.28,671.28, "9MM,4DEG, 26/9 IBF",C1776,HCPCS,278,RC,,,,both,7659,5361.3,,,,,,,,,,,,,,,,,,,Other,1651.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1651.28,1651.28, PSN TIB STM 5 DEG SZ H R,C1776,HCPCS,278,RC,,,,both,2997,2097.9,,,,,,,,,,,,,,,,,,,Other,646.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,646.15,646.15, SKY VARIABLE LRG-D SCREW 18MM T1,272,RC,,,,,,both,399.6,279.72,,,,,,,,,,,,,,,,,,,Other,86.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,86.15,86.15, "8MM,4DEG, 30/9 IBF",C1776,HCPCS,278,RC,,,,both,8741.25,6118.88,,,,,,,,,,,,,,,,,,,Other,1884.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1884.62,1884.62, STAPLER INTRALUMINAL CIRCUlLAR 29 MM,272,RC,,,,,,both,805.88,564.12,,,,,,,,,,,,,,,,,,,Other,173.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,173.74,173.74, PRESTIGE LP CERVICAL DISC 5 X16,L8699,HCPCS,278,RC,,,,both,14152.5,9906.75,,,,,,,,,,,,,,,,,,,Other,3051.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3051.28,3051.28, RAIL CUTTER,C1713,HCPCS,278,RC,,,,both,407.93,285.55,,,,,,,,,,,,,,,,,,,Other,87.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,87.95,87.95, 8.0 MM T1 CAN MTRX PLYAX SCRW 45MM,C1713,HCPCS,278,RC,,,,both,2997,2097.9,,,,,,,,,,,,,,,,,,,Other,646.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,646.15,646.15, CANN HEAD DRILL FOR 3.0MM SCREW,A4649,HCPCS,272,RC,,,,both,1465.2,1025.64,,,,,,,,,,,,,,,,,,,Other,315.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,315.89,315.89, CHARLOTTE 3.0MMX20 MM SCREW,C1713,HCPCS,278,RC,,,,both,2034.63,1424.24,,,,,,,,,,,,,,,,,,,Other,438.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,438.67,438.67, K-WIRE 1.0X150MM,C1713,HCPCS,278,RC,,,,both,216.08,151.26,,,,,,,,,,,,,,,,,,,Other,46.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,46.59,46.59, BIPOLAR SHEL 46MM OD,C1776,HCPCS,278,RC,,,,both,965.7,675.99,,,,,,,,,,,,,,,,,,,Other,208.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,208.2,208.2, Z NAIL CMN 11.5MM X 38CM 130L,C1713,HCPCS,278,RC,,,,both,8215.88,5751.12,,,,,,,,,,,,,,,,,,,Other,1771.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1771.34,1771.34, G01290 CATH BENTSON WIRE .035X180 CM TSF,C1769,HCPCS,272,RC,,,,both,68.45,47.92,,,,,,,,,,,,,,,,,,,Other,14.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.76,14.76, CATH 100CM 4 FR BERNSTEIN,C1769,HCPCS,272,RC,,,,both,55.97,39.18,,,,,,,,,,,,,,,,,,,Other,12.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.06,12.06, ALL POLY PAT CEMENTED 38 MM DIA,C1776,HCPCS,278,RC,,,,both,1082.25,757.58,,,,,,,,,,,,,,,,,,,Other,233.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,233.34,233.34, PSN ASF PS 11MM VE L 6-9 GH,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, 6.0 MM T1 CAN MTRX PLYAX SCRW 45MM,C1713,HCPCS,278,RC,,,,both,2997,2097.9,,,,,,,,,,,,,,,,,,,Other,646.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,646.15,646.15, PSN ASF PS 10MM VE L 6-9 CD,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, EVAL MR8 15 CM MATCH HEAD 3MM,272,RC,,,,,,both,446.05,312.24,,,,,,,,,,,,,,,,,,,Other,96.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,96.17,96.17, EVAL MR8 F2/7 CM TAPER 2.3 MM,272,RC,,,,,,both,306.29,214.4,,,,,,,,,,,,,,,,,,,Other,66.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,66.03,66.03, EVAL MR8 9CM MTL CUT 3MM,272,RC,,,,,,both,535.2,374.64,,,,,,,,,,,,,,,,,,,Other,115.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,115.39,115.39, VIPER 2 LORDOTIC ROD 55MM,C1776,HCPCS,278,RC,,,,both,566.1,396.27,,,,,,,,,,,,,,,,,,,Other,122.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,122.05,122.05, VIPER 2 LORDOTIC ROD 75MM,C1776,HCPCS,278,RC,,,,both,799.2,559.44,,,,,,,,,,,,,,,,,,,Other,172.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,172.3,172.3, 7.0 MM T1 CAN MTRX PLYAX SCRW 40MM,C1713,HCPCS,278,RC,,,,both,3206.96,2244.87,,,,,,,,,,,,,,,,,,,Other,691.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,691.42,691.42, OMNICURVE 11 G 15MM FRACTURE KIT,272,RC,,,,,,both,8125.43,5687.8,,,,,,,,,,,,,,,,,,,Other,1751.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1751.84,1751.84, OSTEOAUGER BONE GRAFT HARVERSTER,272,RC,,,,,,both,1937.89,1356.52,,,,,,,,,,,,,,,,,,,Other,417.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,417.81,417.81, LO PRO SCRW TI 3.5 X 14MM,C1713,HCPCS,278,RC,,,,both,205.79,144.05,,,,,,,,,,,,,,,,,,,Other,44.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.36,44.36, LO PRO SCRW TI 3.5 X 16MM,C1713,HCPCS,278,RC,,,,both,205.79,144.05,,,,,,,,,,,,,,,,,,,Other,44.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.36,44.36, LO PRO SCRW TI 3.5 X 20MM,C1713,HCPCS,278,RC,,,,both,205.79,144.05,,,,,,,,,,,,,,,,,,,Other,44.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.36,44.36, LO PRO SCRW TI 3.5 X 22MM,C1713,HCPCS,278,RC,,,,both,205.79,144.05,,,,,,,,,,,,,,,,,,,Other,44.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.36,44.36, LO PRO SCRW TI 3.5 X 34MM,C1713,HCPCS,278,RC,,,,both,205.79,144.05,,,,,,,,,,,,,,,,,,,Other,44.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.36,44.36, LO PRO SCRW TI 3.5 X 40MM,C1713,HCPCS,278,RC,,,,both,205.79,144.05,,,,,,,,,,,,,,,,,,,Other,44.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.36,44.36, "BONE TAP, 4.0MM",C1713,HCPCS,272,RC,,,,both,514.49,360.14,,,,,,,,,,,,,,,,,,,Other,110.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,110.93,110.93, "LOW PROFILE LAPIDUS PLATE, TITA.",C1713,HCPCS,278,RC,,,,both,3069.76,2148.83,,,,,,,,,,,,,,,,,,,Other,661.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,661.84,661.84, VOYAGER 4.5-7.5 MAS,C1713,HCPCS,278,RC,,,,both,3258.41,2280.89,,,,,,,,,,,,,,,,,,,Other,702.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,702.51,702.51, ADAPTIX CAGE 28X10,L8699,HCPCS,278,RC,,,,both,12004.65,8403.26,,,,,,,,,,,,,,,,,,,Other,2588.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2588.2,2588.2, STERIS RAPTOR GRASPING DEVICE,272,RC,,,,,,both,439.56,307.69,,,,,,,,,,,,,,,,,,,Other,94.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,94.77,94.77, CATH BALLOON MUSTANG 7X40X135CM,C1725,HCPCS,272,RC,,,,both,532.8,372.96,,,,,,,,,,,,,,,,,,,Other,114.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,114.88,114.88, NAVIGATOR 12/14X36CM SHEATH ACCESS,272,RC,,,,,,both,424.28,297,,,,,,,,,,,,,,,,,,,Other,91.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,91.47,91.47, FORCEP RAT TOOTH GRASPING,272,RC,,,,,,both,309.03,216.32,,,,,,,,,,,,,,,,,,,Other,66.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,66.63,66.63, 7X24 CONTOUR URETERAL STENT,278,RC,,,,,,both,371.93,260.35,,,,,,,,,,,,,,,,,,,Other,80.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,80.18,80.18, 7X30 CONTOUR URETERAL STENT,278,RC,,,,,,both,371.93,260.35,,,,,,,,,,,,,,,,,,,Other,80.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,80.18,80.18, STENT PERCUFLEX 8FRX26CM,C1874,HCPCS,278,RC,,,,both,261,182.7,,,,,,,,,,,,,,,,,,,Other,56.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,56.27,56.27, STENT PERCUFLEX 8FRX24CM,C1874,HCPCS,278,RC,,,,both,266.16,186.31,,,,,,,,,,,,,,,,,,,Other,57.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,57.39,57.39, STENT PERCUFLEX 8FRX28CM,C1874,HCPCS,278,RC,,,,both,261,182.7,,,,,,,,,,,,,,,,,,,Other,56.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,56.27,56.27, 6X30 URETERAL STENT,C2617,HCPCS,278,RC,,,,both,371.93,260.35,,,,,,,,,,,,,,,,,,,Other,80.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,80.18,80.18, PSN FEM PS CMT CCR STD SZ6 L,C1776,HCPCS,278,RC,,,,both,5827.5,4079.25,,,,,,,,,,,,,,,,,,,Other,1256.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1256.41,1256.41, PSN ASF PS 13MM VE L 6-9 CD,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, PSN TIB STM 5 DEG SIZE C L,C1776,HCPCS,278,RC,,,,both,2997,2097.9,,,,,,,,,,,,,,,,,,,Other,646.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,646.15,646.15, ARCOS 16X175MM BRCH BODY HI,C1776,HCPCS,278,RC,,,,both,6909.75,4836.83,,,,,,,,,,,,,,,,,,,Other,1489.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1489.75,1489.75, MINIONE BUTTON 20FR SIZE 4.0 CM,272,RC,,,,,,both,452.75,316.93,,,,,,,,,,,,,,,,,,,Other,97.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,97.62,97.62, PSN FEM PS CMT CCR NRW SZ7 L,C1776,HCPCS,278,RC,,,,both,5827.5,4079.25,,,,,,,,,,,,,,,,,,,Other,1256.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1256.41,1256.41, SKY 1 LEVEL PLTE 14MM TI,278,RC,,,,,,both,2315.18,1620.63,,,,,,,,,,,,,,,,,,,Other,499.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,499.15,499.15, DISTRACTOR PIN 14MM,C1713,HCPCS,278,RC,,,,both,274.63,192.24,,,,,,,,,,,,,,,,,,,Other,59.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,59.21,59.21, 7.0 MM T1 CAN MTRX PLYAX SCRW 55MM,C1713,HCPCS,278,RC,,,,both,3206.96,2244.87,,,,,,,,,,,,,,,,,,,Other,691.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,691.42,691.42, PSN ASF PS 14MM VE R 10-12 EF,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, 28MM DIA COCR MOD HD +3MM NK,C1776,HCPCS,278,RC,,,,both,1415.25,990.68,,,,,,,,,,,,,,,,,,,Other,305.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,305.13,305.13, WAVEWRITTER ALPHA 16 GEN KIT,C1820,HCPCS,278,RC,,,,both,68265,47785.5,,,,,,,,,,,,,,,,,,,Other,14717.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14717.93,14717.93, SKY VARIABLE S-D SCREW 12MM T1,272,RC,,,,,,both,411.59,288.11,,,,,,,,,,,,,,,,,,,Other,88.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,88.74,88.74, LUTONIX 018 4X40 4F,C1725,HCPCS,278,RC,,,,both,6327,4428.9,,,,,,,,,,,,,,,,,,,Other,1364.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1364.1,1364.1, ANTI-ROTATION PIN 3.0MM-SM,C1713,HCPCS,278,RC,,,,both,452.75,316.93,,,,,,,,,,,,,,,,,,,Other,97.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,97.62,97.62, SUTURE STRATAFIX 4-0 PS-2,272,RC,,,,,,both,93.09,65.16,,,,,,,,,,,,,,,,,,,Other,20.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.07,20.07, OBRIEN SUPRAPUNIC ACCESS SHEATH,272,RC,,,,,,both,474.36,332.05,,,,,,,,,,,,,,,,,,,Other,102.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,102.27,102.27, 6.0 MM T1 CAN MTRX PLYAX SCRW 50MM,C1713,HCPCS,278,RC,,,,both,3206.96,2244.87,,,,,,,,,,,,,,,,,,,Other,691.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,691.42,691.42, ASCOPE 4 BRONCHO SLIM,272,RC,,,,,,both,922.64,645.85,,,,,,,,,,,,,,,,,,,Other,198.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,198.92,198.92, ASCOPE GASTRO,272,RC,,,,,,both,1714.95,1200.47,,,,,,,,,,,,,,,,,,,Other,369.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,369.74,369.74, 22.2MM DIA COCR MOD HE-3MM NK,C1776,HCPCS,278,RC,,,,both,1415.25,990.68,,,,,,,,,,,,,,,,,,,Other,305.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,305.13,305.13, OVERTUBE ESOPHOGEAL 9.8-11.7 25cm50FR,272,RC,,,,,,both,609.38,426.57,,,,,,,,,,,,,,,,,,,Other,131.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,131.38,131.38, SUB MR8 15 CM MATCH HEAD 3MM,272,RC,,,,,,both,446.54,312.58,,,,,,,,,,,,,,,,,,,Other,96.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,96.28,96.28, PLASMA OVAL BUTTON 24FR URO 12-30DEG,272,RC,,,,,,both,2053.27,1437.29,,,,,,,,,,,,,,,,,,,Other,442.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,442.69,442.69, ARCOS 1 PC 15X175MM BRCH BODY HI,C1776,HCPCS,278,RC,,,,both,6907.75,4835.43,,,,,,,,,,,,,,,,,,,Other,1489.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1489.32,1489.32, PSN ASF PS 11MM VE R 6-9 CD,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, MEDIUM PLASMA LOOP,272,RC,,,,,,both,1700.66,1190.46,,,,,,,,,,,,,,,,,,,Other,366.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,366.67,366.67, UROVAC BLADDER EVACUATOR,272,RC,,,,,,both,100.76,70.53,,,,,,,,,,,,,,,,,,,Other,21.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,21.73,21.73, ACIS-STERILE LORDOTIC/STANDARD-10MM HT,C1889,HCPCS,278,RC,,,,both,3086.91,2160.84,,,,,,,,,,,,,,,,,,,Other,665.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,665.54,665.54, PSN ASF PS 11MM VE L 10-12 GH,C1776,HCPCS,278,RC,,,,both,2915.41,2040.79,,,,,,,,,,,,,,,,,,,Other,628.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,628.56,628.56, VIPER2 1.45 BLUNT GUIDE WIRE,C1769,HCPCS,278,RC,,,,both,171.5,120.05,,,,,,,,,,,,,,,,,,,Other,36.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.98,36.98, SUB ELECTRODE BLADE 6.5 E-Z INSULATED,272,RC,,,,,,both,49.87,34.91,,,,,,,,,,,,,,,,,,,Other,10.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.75,10.75, ZERO-P VA IMP 7MM LORDOTIC,C1776,HCPCS,278,RC,,,,both,6993,4895.1,,,,,,,,,,,,,,,,,,,Other,1507.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1507.69,1507.69, 3.7 TI CERV SPINE SCREW 16MM,C1713,HCPCS,278,RC,,,,both,685.98,480.19,,,,,,,,,,,,,,,,,,,Other,147.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,147.9,147.9, WAVEWRITTER ALPHA 16 GEN KIT(SC1216),C1820,HCPCS,278,RC,,,,both,68265,47785.5,,,,,,,,,,,,,,,,,,,Other,14717.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14717.93,14717.93, "PRECISION S8 ADAPTER, 15CM",272,RC,,,,,,both,2560.56,1792.39,,,,,,,,,,,,,,,,,,,Other,552.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,552.05,552.05, 2X8 O.R. CABLE & EXTENSION,272,RC,,,,,,both,20.6,14.42,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.44,4.44, PSN ASF PS 14MM VE L 6-9 GH,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, PTA SCORING CATH BALLON 3MM 5F SHEATH,C1725,HCPCS,278,RC,,,,both,3663,2564.1,,,,,,,,,,,,,,,,,,,Other,789.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,789.74,789.74, VIABAHN ENDOPROSTHESIS 8MMX5MM 7FR,C1874,HCPCS,278,RC,,,,both,11048.94,7734.26,,,,,,,,,,,,,,,,,,,Other,2382.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2382.15,2382.15, VIABAHN ENDOPROSTHESIS 8MMX15CM 7FR,C1874,HCPCS,278,RC,,,,both,13469.85,9428.9,,,,,,,,,,,,,,,,,,,Other,2904.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2904.1,2904.1, VIPER 2 LORDOTIC ROD 50MM,C1776,HCPCS,278,RC,,,,both,799.2,559.44,,,,,,,,,,,,,,,,,,,Other,172.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,172.3,172.3, SNARE HOT/COLD SMALL .3MMXX230CMX10MM,272,RC,,,,,,both,92.82,64.97,,,,,,,,,,,,,,,,,,,Other,20.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.01,20.01, SNARE HOT/COLD LARGE .3MMX230CMX15MM,272,RC,,,,,,both,92.82,64.97,,,,,,,,,,,,,,,,,,,Other,20.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.01,20.01, "ARTHOCELL PLUS ALLOGRAFT, 5.0CC",C1768,HCPCS,278,RC,,,,both,11655,8158.5,,,,,,,,,,,,,,,,,,,Other,2512.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2512.82,2512.82, CACELLOUS SCREW 3.0 X 16MM,C1713,HCPCS,278,RC,,,,both,157.85,110.5,,,,,,,,,,,,,,,,,,,Other,34.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.04,34.04, LO PRO SCRW TM SS 3.5 X 30MMCORT,C1713,HCPCS,278,RC,,,,both,157.85,110.5,,,,,,,,,,,,,,,,,,,Other,34.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.04,34.04, LO PRO SCRW TM SS 3.5 X 34MMCORT,C1713,HCPCS,278,RC,,,,both,157.85,110.5,,,,,,,,,,,,,,,,,,,Other,34.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.04,34.04, LO PRO SCRW TM SS 3.5 X 38MMCORT,C1713,HCPCS,278,RC,,,,both,157.85,110.5,,,,,,,,,,,,,,,,,,,Other,34.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.04,34.04, LO PRO SCRW TM SS 3.5 X 42MMCORT,C1713,HCPCS,278,RC,,,,both,157.85,110.5,,,,,,,,,,,,,,,,,,,Other,34.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.04,34.04, LO PRO SCRW TM SS 3.5 X 46MMCORT,C1713,HCPCS,278,RC,,,,both,157.85,110.5,,,,,,,,,,,,,,,,,,,Other,34.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.04,34.04, LO PRO SCRW TM SS 3.5 X 48MMCORT,C1713,HCPCS,278,RC,,,,both,157.85,110.5,,,,,,,,,,,,,,,,,,,Other,34.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.04,34.04, LO PRO SCREW SS CANCLUS 4.0X20MM,C1713,HCPCS,278,RC,,,,both,157.85,110.5,,,,,,,,,,,,,,,,,,,Other,34.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.04,34.04, LOCKING MED. HOOK PLT SS 3H,C1713,HCPCS,278,RC,,,,both,3021.98,2115.39,,,,,,,,,,,,,,,,,,,Other,651.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,651.54,651.54, LOCKING THIRD TUBULAR PLT SS 6H,C1713,HCPCS,278,RC,,,,both,879.12,615.38,,,,,,,,,,,,,,,,,,,Other,189.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,189.54,189.54, MEDIUM-LONG PLASMA LOOP 24FR,272,RC,,,,,,both,1700.66,1190.46,,,,,,,,,,,,,,,,,,,Other,366.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,366.67,366.67, LARGE PLASMA LOOP 24FR,272,RC,,,,,,both,1774.47,1242.13,,,,,,,,,,,,,,,,,,,Other,382.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,382.57,382.57, SKY 2 LEVEL PLATE 24MM TI,L8699,HCPCS,278,RC,,,,both,2572.43,1800.7,,,,,,,,,,,,,,,,,,,Other,554.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,554.61,554.61, PILLCAM PATENCY CAPSULE,C1781,HCPCS,272,RC,,,,both,131.2,91.84,,,,,,,,,,,,,,,,,,,Other,28.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28.28,28.28, PILLCAM SB3,C1781,HCPCS,272,RC,,,,both,1872.79,1310.95,,,,,,,,,,,,,,,,,,,Other,403.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,403.77,403.77, DNO CAPSURE PERMANENT FIXATION,272,RC,,,,,,both,1736,1215.2,,,,,,,,,,,,,,,,,,,Other,374.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,374.28,374.28, "MESH, XL LEFT, 12CMX17CM ANATOMICAL",C1781,HCPCS,278,RC,,,,both,859.47,601.63,,,,,,,,,,,,,,,,,,,Other,185.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,185.3,185.3, "MESH, XL RIGHT, 12CMX17CM ANATOMICAL",C1781,HCPCS,278,RC,,,,both,1847.15,1293.01,,,,,,,,,,,,,,,,,,,Other,398.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,398.24,398.24, "MESH, LG LEFT, 10CMX16CM ANATOMICAL",C1781,HCPCS,278,RC,,,,both,782.55,547.79,,,,,,,,,,,,,,,,,,,Other,168.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,168.72,168.72, "MESH, LG RIGHT, 10CMX16CM ANATOMICAL",C1781,HCPCS,278,RC,,,,both,1678.32,1174.82,,,,,,,,,,,,,,,,,,,Other,361.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,361.85,361.85, GENEX 10CC KTW/BEAD MOLD TRAY,C1713,HCPCS,278,RC,,,,both,12499.99,8749.99,,,,,,,,,,,,,,,,,,,Other,2695,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2695,2695, BACTISURE WOUND LAVAGE WW,C1713,HCPCS,272,RC,,,,both,2497.5,1748.25,,,,,,,,,,,,,,,,,,,Other,538.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,538.46,538.46, CONTINUUM VIVACIT-E NEUTRAL LINER 36X62,C1776,HCPCS,278,RC,,,,both,2997,2097.9,,,,,,,,,,,,,,,,,,,Other,646.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,646.15,646.15, HERNIA PATCH MED 2.5IN VENTALEX ST,C1781,HCPCS,278,RC,,,,both,1593.07,1115.15,,,,,,,,,,,,,,,,,,,Other,343.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,343.47,343.47, HERNIA PATCH LG 3.2 IN VENTRALEX ST,C1781,HCPCS,278,RC,,,,both,2060.6,1442.42,,,,,,,,,,,,,,,,,,,Other,444.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,444.26,444.26, SEGURA 2.4 BASKET STAINLESS STEEL,272,RC,,,,,,both,628.06,439.64,,,,,,,,,,,,,,,,,,,Other,135.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,135.41,135.41, V-LOC180 2-0 GRN GS22 STUTURE,272,RC,,,,,,both,121.52,85.06,,,,,,,,,,,,,,,,,,,Other,26.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.2,26.2, SUTURE 0 VICRYL UR-6 VCP603H,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, PSN ASF PS 16MM VE R 6-9 CD,C1776,HCPCS,278,RC,,,,both,2880.03,2016.02,,,,,,,,,,,,,,,,,,,Other,620.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,620.94,620.94, GUIDEWIRE .035X450CM ANGLED DREAMWIRE,A4649,HCPCS,272,RC,,,,both,598.28,418.8,,,,,,,,,,,,,,,,,,,Other,128.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,128.99,128.99, FAST 2.0MM DRILL BIT MINIQUICK,272,RC,,,,,,both,179.82,125.87,,,,,,,,,,,,,,,,,,,Other,38.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,38.77,38.77, 2.5MM LOCK PLATE STRAIGHT,C1713,HCPCS,278,RC,,,,both,1538.46,1076.92,,,,,,,,,,,,,,,,,,,Other,331.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,331.69,331.69, 2.0/2.5MM/DRIVER BIT,C1713,HCPCS,278,RC,,,,both,144,100.8,,,,,,,,,,,,,,,,,,,Other,31.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,31.05,31.05, PEG FULL THREAD 2.5X15MM,C1713,HCPCS,278,RC,,,,both,319.68,223.78,,,,,,,,,,,,,,,,,,,Other,68.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.92,68.92, PEG FULL THREAD 2.5X16MM,C1713,HCPCS,278,RC,,,,both,319.68,223.78,,,,,,,,,,,,,,,,,,,Other,68.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.92,68.92, 1.7 MM SQAURE DRIVER,C1713,HCPCS,278,RC,,,,both,275.79,193.05,,,,,,,,,,,,,,,,,,,Other,59.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,59.46,59.46, DVR LOCK NARROW R,C1713,HCPCS,278,RC,,,,both,2754.54,1928.18,,,,,,,,,,,,,,,,,,,Other,593.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,593.88,593.88, "CONV SUTURE SILK 2-0 BB 30"" ETH K883H",272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, VIABAHN ENDOPROSTHESIS,C1874,HCPCS,278,RC,,,,both,12087.9,8461.53,,,,,,,,,,,,,,,,,,,Other,2606.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2606.15,2606.15, ULTRAVERSE 5X40X130 5FR SHEATH,C1725,HCPCS,272,RC,,,,both,1202.13,841.49,,,,,,,,,,,,,,,,,,,Other,259.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,259.18,259.18, PSN FEM PS CMT TIV STD SZ 7L,C1776,HCPCS,278,RC,,,,both,7142.85,5000,,,,,,,,,,,,,,,,,,,Other,1540,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1540,1540, CANNULATED COMPRESSION SCREW W/ S.S.,C1713,HCPCS,278,RC,,,,both,1262.14,883.5,,,,,,,,,,,,,,,,,,,Other,272.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,272.12,272.12, ENDURITY PACEMAKER GENERATOR,C1785,HCPCS,275,RC,,,,both,14319,10023.3,,,,,,,,,,,,,,,,,,,Other,3087.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3087.18,3087.18, OMNICURVE 11G 20 MM FX KIT,C1889,HCPCS,278,RC,,,,both,8125.43,5687.8,,,,,,,,,,,,,,,,,,,Other,1751.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1751.84,1751.84, SUTURE ETHIBOND 0 SH ETHX834H,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, 10MM STERILE MARGIN MARKER CHARM,A4648,HCPCS,278,RC,,,,both,79.95,55.97,,,,,,,,,,,,,,,,,,,Other,17.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.24,17.24, MARGIN MARKER STERILE INK KIT,A4648,HCPCS,278,RC,,,,both,553.15,387.21,,,,,,,,,,,,,,,,,,,Other,119.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,119.26,119.26, FIBERGRAFT BG PUTTY M 6CC,C1713,HCPCS,278,RC,,,,both,4137.09,2895.96,,,,,,,,,,,,,,,,,,,Other,891.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,891.96,891.96, "NEEDLE SPINAL 22GX7"", SPINOCAN",272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, PSN ASF PS 12MM VE R 6-9 EF,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, CODA ACP 2 LEVEL PLATE 26MM,C1713,HCPCS,278,RC,,,,both,1998,1398.6,,,,,,,,,,,,,,,,,,,Other,430.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,430.77,430.77, CODA VASD SCREW 3.5 X 16MM,C1713,HCPCS,278,RC,,,,both,333,233.1,,,,,,,,,,,,,,,,,,,Other,71.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.79,71.79, CODA ACP 1 LEVEL PLTE 10MM,C1713,HCPCS,278,RC,,,,both,1998,1398.6,,,,,,,,,,,,,,,,,,,Other,430.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,430.77,430.77, PSN ASF PS 12MM VE L 10-11 EF,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, 4-0 V-LOCK 90 MONOFILAMENT SUTURE,272,RC,,,,,,both,89.01,62.31,,,,,,,,,,,,,,,,,,,Other,19.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.19,19.19, ASORBABLE HEMOSTAT 2'X3' SURGICEL,258,RC,,,,,,both,119.99,83.99,,,,,,,,,,,,,,,,,,,Other,25.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.87,25.87, BIOMET BONE CEMENT R 1X40 US,C1713,HCPCS,278,RC,,,,both,199.8,139.86,,,,,,,,,,,,,,,,,,,Other,43.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.08,43.08, VARIABLE SELF DRILLING SCREW 3.5X14,C1713,HCPCS,278,RC,,,,both,333,233.1,,,,,,,,,,,,,,,,,,,Other,71.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.79,71.79, MODULAR NECK K 12/14 TAPER,C1776,HCPCS,278,RC,,,,both,1269.06,888.34,,,,,,,,,,,,,,,,,,,Other,273.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,273.61,273.61, "CONTINUUM VIVACIT-E NEUTRAL LINER, II 36",C1776,HCPCS,278,RC,,,,both,2997,2097.9,,,,,,,,,,,,,,,,,,,Other,646.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,646.15,646.15, WAVEWRITER ALPHA 16 GEN KIT(SC-1416),C1820,HCPCS,278,RC,,,,both,61605,43123.5,,,,,,,,,,,,,,,,,,,Other,13282.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13282.04,13282.04, VERSASTEP PLUS 12MM,272,RC,,,,,,both,494.14,345.9,,,,,,,,,,,,,,,,,,,Other,106.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,106.54,106.54, SIGNA POWERSHELL,272,RC,,,,,,both,1111.65,778.16,,,,,,,,,,,,,,,,,,,Other,239.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,239.67,239.67, ENDO RETRACT II,272,RC,,,,,,both,1053.81,737.67,,,,,,,,,,,,,,,,,,,Other,227.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,227.2,227.2, ENDO TAN RELOAD 45MM,272,RC,,,,,,both,1311.42,917.99,,,,,,,,,,,,,,,,,,,Other,282.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,282.74,282.74, ENDO CATCH II,272,RC,,,,,,both,827.67,579.37,,,,,,,,,,,,,,,,,,,Other,178.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,178.45,178.45, CODA ACP 1 LEVEL PLTE 12MM,C1713,HCPCS,278,RC,,,,both,1998,1398.6,,,,,,,,,,,,,,,,,,,Other,430.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,430.77,430.77, *DNO NEUROSTIM PATIENT TRIAL KIT 72,272,RC,,,,,,both,301.9,211.33,,,,,,,,,,,,,,,,,,,Other,65.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,65.09,65.09, SCOUT 7.5 CM DELIVERY NEEDLE AND REFLECT,A4648,HCPCS,278,RC,,,,both,1714.95,1200.47,,,,,,,,,,,,,,,,,,,Other,369.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,369.74,369.74, 5.5MM TI CURVED ROD 125MM,278,RC,,,,,,both,566.1,396.27,,,,,,,,,,,,,,,,,,,Other,122.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,122.05,122.05, 4-0 V-LOCK 90 MONO COCML 24MML P-143/8,272,RC,,,,,,both,87.82,61.47,,,,,,,,,,,,,,,,,,,Other,18.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.93,18.93, BIPOLAR SHEL 45MM OD,C1776,HCPCS,278,RC,,,,both,965.7,675.99,,,,,,,,,,,,,,,,,,,Other,208.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,208.2,208.2, PSN ASF PS 13MM VE L 6-9 GH,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, TENODESIS GRAFT SIZING KIT W/FIBERLOOP T,C1776,HCPCS,278,RC,,,,both,1080.59,756.41,,,,,,,,,,,,,,,,,,,Other,232.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,232.98,232.98, SUTURE VICRYL 3-0 TIES ETH J910T,272,RC,,,,,,both,25.17,17.62,,,,,,,,,,,,,,,,,,,Other,5.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.43,5.43, SYNFIX EVO PROTECTION SLEEVE+AWL,C1713,HCPCS,278,RC,,,,both,339.16,237.41,,,,,,,,,,,,,,,,,,,Other,73.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,73.13,73.13, SYNFIX EVO THREAD LOCK SLEEVE-ST,C1713,HCPCS,278,RC,,,,both,992.34,694.64,,,,,,,,,,,,,,,,,,,Other,213.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,213.94,213.94, SYNFIX EVO FINE TIP SCREW/25MM-ST,C1713,HCPCS,278,RC,,,,both,1665,1165.5,,,,,,,,,,,,,,,,,,,Other,358.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,358.97,358.97, SYNFIX EVO SPACER SM DEEP 10.5MM/10 DEG,C1821,HCPCS,278,RC,,,,both,14985,10489.5,,,,,,,,,,,,,,,,,,,Other,3230.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3230.77,3230.77, PSN ASF PS 16MM VE L 6-9 EF,C1776,HCPCS,278,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, "CONTINUUM VIVACIT-E NEUTRAL LINER, HH 32",C1776,HCPCS,278,RC,,,,both,2997,2097.9,,,,,,,,,,,,,,,,,,,Other,646.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,646.15,646.15, CER OPTION TYPE 1 TPR SLEEVE -3,C1889,HCPCS,278,RC,,,,both,342.99,240.09,,,,,,,,,,,,,,,,,,,Other,73.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,73.95,73.95, MINIONE BUTTON 16FR SIZE 2.3CM,272,RC,,,,,,both,439.56,307.69,,,,,,,,,,,,,,,,,,,Other,94.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,94.77,94.77, MINIONE BUTTON 16FR SIZE 2.5 CM,272,RC,,,,,,both,439.56,307.69,,,,,,,,,,,,,,,,,,,Other,94.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,94.77,94.77, PROLENE SOFT MESH 50X50,C1781,HCPCS,278,RC,,,,both,2026.86,1418.8,,,,,,,,,,,,,,,,,,,Other,436.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,436.99,436.99, STENT WALLFLEX ESOPHAGEAL 18MMX15.3CMX78,C1874,HCPCS,278,RC,,,,both,8320.31,5824.22,,,,,,,,,,,,,,,,,,,Other,1793.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1793.86,1793.86, STENT WALLFLEX ESOPHAGEAL 23MMX10.5CMX78,C1874,HCPCS,278,RC,,,,both,8320.31,5824.22,,,,,,,,,,,,,,,,,,,Other,1793.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1793.86,1793.86, PLEURX CATHETER ACCESS KIT SYSTEM,272,RC,,,,,,both,111.25,77.88,,,,,,,,,,,,,,,,,,,Other,23.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.99,23.99, APLIGRAF 44CM,Q4186,HCPCS,636,RC,,,,both,4658,3260.6,,,,,,,,,,,,,,,,,,,Other,1004.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.87,1004.26, CODA VASD SCREW 3.5 X 18MM,C1713,HCPCS,278,RC,,,,both,333,233.1,,,,,,,,,,,,,,,,,,,Other,71.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.79,71.79, X-PAC 12X32MM LORDOTIC,C1776,HCPCS,278,RC,,,,both,17898.75,12529.13,,,,,,,,,,,,,,,,,,,Other,3858.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3858.98,3858.98, CATH MUSTANG 12X40X75,C1725,HCPCS,278,RC,,,,both,532.8,372.96,,,,,,,,,,,,,,,,,,,Other,114.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,114.88,114.88, VIABAHN SX ENDO HEPARIN 10MMX15CM,C1874,HCPCS,278,RC,,,,both,13489.83,9442.88,,,,,,,,,,,,,,,,,,,Other,2908.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2908.4,2908.4, VIABAHN SX ENDO HEPARIN 9MMX10CM,C1874,HCPCS,278,RC,,,,both,11841.48,8289.04,,,,,,,,,,,,,,,,,,,Other,2553.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2553.03,2553.03, PLEURX CATH KIT 15.5FR W/ 4 1L BOTTLES,272,RC,,,,,,both,3996,2797.2,,,,,,,,,,,,,,,,,,,Other,861.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,861.54,861.54, SYNFIX EVO SPACER SM 10.5MM/6 DEG,C1713,HCPCS,278,RC,,,,both,14985,10489.5,,,,,,,,,,,,,,,,,,,Other,3230.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3230.77,3230.77, SYNFIX EVO FINE TIP SCREW/30MM-ST,C1713,HCPCS,278,RC,,,,both,1581.75,1107.23,,,,,,,,,,,,,,,,,,,Other,341.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,341.03,341.03, WAVEWRITER ALPHA GEN KIT(SC-1232),C1820,HCPCS,278,RC,,,,both,59940,41958,,,,,,,,,,,,,,,,,,,Other,12923.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12923.06,12923.06, COVEREDGE 50X4X8 LEAD KIT,C1820,HCPCS,278,RC,,,,both,14985,10489.5,,,,,,,,,,,,,,,,,,,Other,3230.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3230.77,3230.77, DNO SUTURE EHIBOND V-37 GRN 4X30IN,272,RC,,,,,,both,70.73,49.51,,,,,,,,,,,,,,,,,,,Other,15.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.25,15.25, SUTURE MERSILENE BP-1 12INX3/16IN,272,RC,,,,,,both,165.19,115.63,,,,,,,,,,,,,,,,,,,Other,35.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.61,35.61, CODA ACP 2 LEVEL PLATE 24MM,C1713,HCPCS,278,RC,,,,both,1998,1398.6,,,,,,,,,,,,,,,,,,,Other,430.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,430.77,430.77, SCREW 2.7MM 26MM,C1713,HCPCS,278,RC,,,,both,221.98,155.39,,,,,,,,,,,,,,,,,,,Other,47.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.86,47.86, LOCK SCREW SQUARE 2.7MM 24MM,C1713,HCPCS,278,RC,,,,both,369.96,258.97,,,,,,,,,,,,,,,,,,,Other,79.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,79.76,79.76, LOCK SCREW SQUARE 2.7MM 22MM,C1713,HCPCS,278,RC,,,,both,369.96,258.97,,,,,,,,,,,,,,,,,,,Other,79.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,79.76,79.76, LP NON LOCK 2.7MMX 20MM,C1713,HCPCS,278,RC,,,,both,221.98,155.39,,,,,,,,,,,,,,,,,,,Other,47.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.86,47.86, DVR CROSSLOCK MINI PLATE LEFT,C1713,HCPCS,278,RC,,,,both,2754.54,1928.18,,,,,,,,,,,,,,,,,,,Other,593.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,593.88,593.88, TRILOGY ACET SHELL 54MM,C1776,HCPCS,278,RC,,,,both,2863.8,2004.66,,,,,,,,,,,,,,,,,,,Other,617.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,617.44,617.44, BONE SCREW 6.5X40 SELF-TAP,C1713,HCPCS,278,RC,,,,both,233.1,163.17,,,,,,,,,,,,,,,,,,,Other,50.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.25,50.25, TRILOGY MODULAR CUP 10 DEG 50/52/54X32,C1776,HCPCS,278,RC,,,,both,2664,1864.8,,,,,,,,,,,,,,,,,,,Other,574.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,574.36,574.36, RM PRIMARY STEM 12MM STANDARD,C1776,HCPCS,278,RC,,,,both,6909.75,4836.83,,,,,,,,,,,,,,,,,,,Other,1489.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1489.75,1489.75, "BIOLOX DELTA FEM HEAD, 32MM, +7MM",C1776,HCPCS,278,RC,,,,both,2486.68,1740.68,,,,,,,,,,,,,,,,,,,Other,536.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,536.13,536.13, SCREW 2.4 LOCKING 2.7MM 20MM,C1713,HCPCS,278,RC,,,,both,369.96,258.97,,,,,,,,,,,,,,,,,,,Other,79.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,79.76,79.76, MULTIDIRECTIONAL SCREW 2.7 18MM,C1713,HCPCS,278,RC,,,,both,534.76,374.33,,,,,,,,,,,,,,,,,,,Other,115.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,115.3,115.3, MULTIDIRECTIONAL SCREW 2.7MM 22MM,C1713,HCPCS,278,RC,,,,both,534.76,374.33,,,,,,,,,,,,,,,,,,,Other,115.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,115.3,115.3, PSN ASF PS 10MM PLY L 6-9 EF,C1776,HCPCS,278,RC,,,,both,2081.25,1456.88,,,,,,,,,,,,,,,,,,,Other,448.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.72,448.72, PHASIX ST MESH 7CMX10CM,C1781,HCPCS,278,RC,,,,both,8307.68,5815.38,,,,,,,,,,,,,,,,,,,Other,1791.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1791.14,1791.14, STRAIGHT URETHRAL DILATOR SET 8FR-24FR,272,RC,,,,,,both,1201.8,841.26,,,,,,,,,,,,,,,,,,,Other,259.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,259.11,259.11, S-CURVE URETHTHAL DILATOR 26FR,272,RC,,,,,,both,164.84,115.39,,,,,,,,,,,,,,,,,,,Other,35.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.53,35.53, S-CURVE URETHRAL DILATOR 24FR,272,RC,,,,,,both,164.84,115.39,,,,,,,,,,,,,,,,,,,Other,35.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.53,35.53, LUTONIX 018 6X80,C1725,HCPCS,278,RC,,,,both,6516.81,4561.77,,,,,,,,,,,,,,,,,,,Other,1405.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1405.03,1405.03, BONE SCREW 6.5X15 SELF TAP,C1713,HCPCS,278,RC,,,,both,233.1,163.17,,,,,,,,,,,,,,,,,,,Other,50.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.25,50.25, "TM PRIMARY STEM, 10 MM STANDARD",C1776,HCPCS,278,RC,,,,both,6909.75,4836.83,,,,,,,,,,,,,,,,,,,Other,1489.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1489.75,1489.75, "BIOLOX DELTA FEM HEAD, 32MM, +3.5MM",C1776,HCPCS,278,RC,,,,both,2486.68,1740.68,,,,,,,,,,,,,,,,,,,Other,536.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,536.13,536.13, TRILOGY ACET SHELL 50MM,C1776,HCPCS,278,RC,,,,both,2863.8,2004.66,,,,,,,,,,,,,,,,,,,Other,617.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,617.44,617.44, "12MM,4DEG, 26/9 IBF",C1776,HCPCS,278,RC,,,,both,8741.25,6118.88,,,,,,,,,,,,,,,,,,,Other,1884.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1884.62,1884.62, V92 FC+ BONE MATRIX 5CC,C1713,HCPCS,278,RC,,,,both,16650,11655,,,,,,,,,,,,,,,,,,,Other,3589.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3589.74,3589.74, BEAST PLUS PUTTY 5CC,C1713,HCPCS,278,RC,,,,both,6327,4428.9,,,,,,,,,,,,,,,,,,,Other,1364.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1364.1,1364.1, BEAST PLUS PUTTY 10CC,C1713,HCPCS,278,RC,,,,both,11655,8158.5,,,,,,,,,,,,,,,,,,,Other,2512.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2512.82,2512.82, "TTC NAIL, 10X200MM R STRL",C1713,HCPCS,278,RC,,,,both,10989,7692.3,,,,,,,,,,,,,,,,,,,Other,2369.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2369.23,2369.23, HNDFT NAIL CORSSING SCREW 5X30MM,C1713,HCPCS,278,RC,,,,both,1831.5,1282.05,,,,,,,,,,,,,,,,,,,Other,394.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,394.87,394.87, HNDFT MAIL CROSSING SCREW 5X32MM,C1713,HCPCS,278,RC,,,,both,1831.5,1282.05,,,,,,,,,,,,,,,,,,,Other,394.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,394.87,394.87, BONE FENESTRATION PERFORATOR,272,RC,,,,,,both,1032.3,722.61,,,,,,,,,,,,,,,,,,,Other,222.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,222.57,222.57, K-WR SGL END TRCR TIP SMTH 20.X200MM,278,RC,,,,,,both,172.2,120.54,,,,,,,,,,,,,,,,,,,Other,37.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.12,37.12, K-WR SGL END TRCR TIP SMTH2.3X300MM,278,RC,,,,,,both,139.86,97.9,,,,,,,,,,,,,,,,,,,Other,30.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,30.15,30.15, PREC GD DRL PIN 3X320MM,272,RC,,,,,,both,1498.5,1048.95,,,,,,,,,,,,,,,,,,,Other,323.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,323.08,323.08, "DRILL 7.0X200MM CAN 3/16"" SQ",272,RC,,,,,,both,2314.35,1620.05,,,,,,,,,,,,,,,,,,,Other,498.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,498.98,498.98, STEPPED REAMER CAN 8.0MMTO 13.00MM,272,RC,,,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, "BALL TIPPED GD ROD ,3X550 MM",272,RC,,,,,,both,1498.5,1048.95,,,,,,,,,,,,,,,,,,,Other,323.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,323.08,323.08, DRILL 4.6X300MM SLF TRCR 3/16 SQ,272,RC,,,,,,both,2314.35,1620.05,,,,,,,,,,,,,,,,,,,Other,498.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,498.98,498.98, "DRILL 3.8X250MM SLF TRCR 3/16"" SQ",272,RC,,,,,,both,2314.35,1620.05,,,,,,,,,,,,,,,,,,,Other,498.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,498.98,498.98, "HNDFT NAIL, THDED PEG 7.2X75MM",C1713,HCPCS,278,RC,,,,both,5294.7,3706.29,,,,,,,,,,,,,,,,,,,Other,1141.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1141.53,1141.53, WIRE FIXATION BOLT,272,RC,,,,,,both,982.35,687.65,,,,,,,,,,,,,,,,,,,Other,211.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,211.8,211.8, CONNECTION BOLT 16MM,272,RC,,,,,,both,123,86.1,,,,,,,,,,,,,,,,,,,Other,26.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.52,26.52, M6 CONNEC,272,RC,,,,,,both,82,57.4,,,,,,,,,,,,,,,,,,,Other,17.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.68,17.68, WIRE 1.8X400 SMOOTH HALF POINT,272,RC,,,,,,both,815.85,571.1,,,,,,,,,,,,,,,,,,,Other,175.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,175.9,175.9, FULL RING 160MM TABS,272,RC,,,,,,both,5384.61,3769.23,,,,,,,,,,,,,,,,,,,Other,1160.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1160.92,1160.92, FOOT PLATE 160MM,272,RC,,,,,,both,6183.81,4328.67,,,,,,,,,,,,,,,,,,,Other,1333.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1333.23,1333.23, ARCH RING 160MM,272,RC,,,,,,both,2787.21,1951.05,,,,,,,,,,,,,,,,,,,Other,600.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,600.93,600.93, THREADED PILLAR 75MM,272,RC,,,,,,both,1638.36,1146.85,,,,,,,,,,,,,,,,,,,Other,353.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,353.23,353.23, THREADED PILLAR 250MM,272,RC,,,,,,both,1888.11,1321.68,,,,,,,,,,,,,,,,,,,Other,407.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,407.07,407.07, HNDFT NAIL INT COMP SCW 3MM,C1713,HCPCS,278,RC,,,,both,1631.1,1141.77,,,,,,,,,,,,,,,,,,,Other,351.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,351.66,351.66, LP NON LOCK 2.7MM 24MM,C1713,HCPCS,278,RC,,,,both,221.98,155.39,,,,,,,,,,,,,,,,,,,Other,47.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.86,47.86, HNDFT NAIL SHOULDERED END CAP ST,C1713,HCPCS,278,RC,,,,both,1631.1,1141.77,,,,,,,,,,,,,,,,,,,Other,351.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,351.66,351.66, EVAL CATH POWER PICC 5FR 55CM DUAL-LUMEN,272,RC,,,,,,both,322.98,226.09,,,,,,,,,,,,,,,,,,,Other,69.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,69.64,69.64, "MESH W/ECHO PS2 CIRCLE 15CM 6""",C1781,HCPCS,278,RC,,,,both,3130.2,2191.14,,,,,,,,,,,,,,,,,,,Other,674.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,674.87,674.87, MINIONE BALLON BUTTON 18FR SIZE 3.5CM,272,RC,,,,,,both,439.56,307.69,,,,,,,,,,,,,,,,,,,Other,94.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,94.77,94.77, PATELLA REAMER BLADE SIZE 29,272,RC,,,,,,both,494.51,346.16,,,,,,,,,,,,,,,,,,,Other,106.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,106.61,106.61, PSN ALL POLY PAT PLY 35MM,C1776,HCPCS,278,RC,,,,both,1082.25,757.58,,,,,,,,,,,,,,,,,,,Other,233.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,233.34,233.34, TRILOGY ACET SHELL 62MM,C1776,HCPCS,278,RC,,,,both,2863.8,2004.66,,,,,,,,,,,,,,,,,,,Other,617.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,617.44,617.44, XLPE 10 DEG PLY LINER 62X36,C1776,HCPCS,278,RC,,,,both,2664,1864.8,,,,,,,,,,,,,,,,,,,Other,574.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,574.36,574.36, TM PRIM FEM ST 14MM,C1776,HCPCS,278,RC,,,,both,6909.75,4836.83,,,,,,,,,,,,,,,,,,,Other,1489.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1489.75,1489.75, PSN ASF PS 13MMPLY R 6-9 EF,C1776,HCPCS,278,RC,,,,both,2081.25,1456.88,,,,,,,,,,,,,,,,,,,Other,448.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.72,448.72, SUPRAPUBIC PEELAWAY ACESS SHEATH 20 FR,272,RC,,,,,,both,506.83,354.78,,,,,,,,,,,,,,,,,,,Other,109.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,109.27,109.27, REVOLUTION CMS W/FEMORAL BREAK NOZZLE,272,RC,,,,,,both,290.17,203.12,,,,,,,,,,,,,,,,,,,Other,62.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,62.56,62.56, GRAFT 6MMX80CM 70CM RING THIN WALL,C1768,HCPCS,278,RC,,,,both,5381.28,3766.9,,,,,,,,,,,,,,,,,,,Other,1160.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1160.2,1160.2, EYE 120MM 18G SHAPE TRUMARK MARKER,A4648,HCPCS,278,RC,,,,both,183.15,128.21,,,,,,,,,,,,,,,,,,,Other,39.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.48,39.48, F/M ACET SHELL 58MMOD CLUSTER,C1776,HCPCS,278,RC,,,,both,2863.8,2004.66,,,,,,,,,,,,,,,,,,,Other,617.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,617.44,617.44, XLPE 10 DEG PLY LINER 58X36,C1776,HCPCS,278,RC,,,,both,2664,1864.8,,,,,,,,,,,,,,,,,,,Other,574.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,574.36,574.36, TM PRIM FEM ST 13MM,C1776,HCPCS,278,RC,,,,both,6909.75,4836.83,,,,,,,,,,,,,,,,,,,Other,1489.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1489.75,1489.75, "BIOLOX DELTA FEM HEAD12/14, 36MMX, +3.5M",C1776,HCPCS,278,RC,,,,both,2486.68,1740.68,,,,,,,,,,,,,,,,,,,Other,536.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,536.13,536.13, TM PRIM FEM ST 16M,C1776,HCPCS,278,RC,,,,both,6905.75,4834.03,,,,,,,,,,,,,,,,,,,Other,1488.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1488.88,1488.88, ZB 12/14 COCHR HD 36 MMX T16.5,C1776,HCPCS,278,RC,,,,both,1415,990.5,,,,,,,,,,,,,,,,,,,Other,305.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,305.07,305.07, BIO A TISSUE REINFORCEMENT 9X15,C1781,HCPCS,278,RC,,,,both,2480.85,1736.6,,,,,,,,,,,,,,,,,,,Other,534.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,534.87,534.87, SCOUT MINI REFLECTOR 16GX7.5CM,A4648,HCPCS,278,RC,,,,both,1714.95,1200.47,,,,,,,,,,,,,,,,,,,Other,369.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,369.74,369.74, AVAFLEX CURVED NEEDLE W/O CANNULA,272,RC,,,,,,both,1210.75,847.53,,,,,,,,,,,,,,,,,,,Other,261.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,261.04,261.04, AUTOPEX M4 MIXER W/VERTAPLEXHV,C1713,HCPCS,278,RC,,,,both,3068.56,2147.99,,,,,,,,,,,,,,,,,,,Other,661.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,661.58,661.58, COAXIAL FEMORAL CANAL TIP,272,RC,,,,,,both,37.6,26.32,,,,,,,,,,,,,,,,,,,Other,8.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.1,8.1, BONE PREP KIT,272,RC,,,,,,both,391.61,274.13,,,,,,,,,,,,,,,,,,,Other,84.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,84.43,84.43, F/M ACET SHELL 52MMOD CLUSTER,C1776,HCPCS,278,RC,,,,both,2863.8,2004.66,,,,,,,,,,,,,,,,,,,Other,617.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,617.44,617.44, VERSYS HERITAGE12X125MM ST,C1776,HCPCS,278,RC,,,,both,4212.45,2948.72,,,,,,,,,,,,,,,,,,,Other,908.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,908.21,908.21, DISTAL CENTRALIZER 9MM,C1776,HCPCS,278,RC,,,,both,183.15,128.21,,,,,,,,,,,,,,,,,,,Other,39.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.48,39.48, "MESH VICRYL KNITTED 6""X6""",C1781,HCPCS,278,RC,,,,both,1165.33,815.73,,,,,,,,,,,,,,,,,,,Other,251.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,251.24,251.24, REPOC SERFAS PROBE 90-S CRUISE ABLATION,272,RC,,,,,,both,233.63,163.54,,,,,,,,,,,,,,,,,,,Other,50.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.37,50.37, SYNFIXEVO SPCR MD/12MM HT/10STER,C1821,HCPCS,278,RC,,,,both,10822.5,7575.75,,,,,,,,,,,,,,,,,,,Other,2333.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2333.33,2333.33, SYNFIX EVO FINE TIP SCREW 30MM,C1713,HCPCS,278,RC,,,,both,1665,1165.5,,,,,,,,,,,,,,,,,,,Other,358.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,358.97,358.97, XENOGRAFT OASIS 5CMX7CM SHEET 3-LAYER,Q4124,HCPCS,278,RC,,,,both,1456.88,1019.82,,,,,,,,,,,,,,,,,,,Other,314.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.87,314.1, STRYKER SUCTION/IRRIGATION PS,272,RC,,,,,,both,129.67,90.77,,,,,,,,,,,,,,,,,,,Other,27.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,27.96,27.96, PATELLA REAMER BLADE SIZE 32,272,RC,,,,,,both,509.35,356.55,,,,,,,,,,,,,,,,,,,Other,109.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,109.82,109.82, PSN ASF R 12MM 6-12 GH,C1776,HCPCS,278,RC,,,,both,2081.25,1456.88,,,,,,,,,,,,,,,,,,,Other,448.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.72,448.72, EXPLANT K-WIRE 1.6,272,RC,,,,,,both,136.65,95.66,,,,,,,,,,,,,,,,,,,Other,29.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,29.46,29.46, SAW BLADE 9MMX31MM,272,RC,,,,,,both,108.23,75.76,,,,,,,,,,,,,,,,,,,Other,23.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.33,23.33, "SUTURE ULTRA BRAID #2 BLUE 38"" CO BRAID",272,RC,,,,,,both,94.71,66.3,,,,,,,,,,,,,,,,,,,Other,20.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.42,20.42, SUTURE ULTRA BRAID #2 WHITE 38' CO BRAID,272,RC,,,,,,both,95.2,66.64,,,,,,,,,,,,,,,,,,,Other,20.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.52,20.52, TROCAR LAPAROSCOPIC KII FIOS 12X100MM Z-,272,RC,,,,,,both,88.15,61.71,,,,,,,,,,,,,,,,,,,Other,19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19,19, PHASIX ST MESH 4INX4IN,C1781,HCPCS,278,RC,,,,both,11432.89,8003.02,,,,,,,,,,,,,,,,,,,Other,2464.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2464.94,2464.94, TIGHTROPE II WITH DEPLOYING SUTURE,C1713,HCPCS,278,RC,,,,both,1703.3,1192.31,,,,,,,,,,,,,,,,,,,Other,367.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,367.24,367.24, "DRL PIN, ACL T-ROPE",272,RC,,,,,,both,457.88,320.52,,,,,,,,,,,,,,,,,,,Other,98.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,98.72,98.72, "DISPS KIT, TRANS TIB ACL W/SAWBLADE",272,RC,,,,,,both,824.18,576.93,,,,,,,,,,,,,,,,,,,Other,177.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,177.69,177.69, SUTURE TAPE FIBERLOOPW/NDL WH/BL,C1713,HCPCS,278,RC,,,,both,256.41,179.49,,,,,,,,,,,,,,,,,,,Other,55.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,55.28,55.28, BIOCRYL RAPIDE SHEATH AND SCREW 8X30MM,C1773,HCPCS,278,RC,,,,both,3949.38,2764.57,,,,,,,,,,,,,,,,,,,Other,851.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,851.48,851.48, SCREW 2.7MM 22MM,C1713,HCPCS,278,RC,,,,both,221.98,155.39,,,,,,,,,,,,,,,,,,,Other,47.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.86,47.86, MULTIDIRECTIONAL SCREW 2.7MM 20MM,C1713,HCPCS,278,RC,,,,both,534.76,374.33,,,,,,,,,,,,,,,,,,,Other,115.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,115.3,115.3, CODA ACP 3 LEVEL PLTE 45MM,C1713,HCPCS,278,RC,,,,both,2164.5,1515.15,,,,,,,,,,,,,,,,,,,Other,466.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,466.67,466.67, SYNFIX EVO SPACER SM 10.5MM/10DEG,C1713,HCPCS,278,RC,,,,both,10822.5,7575.75,,,,,,,,,,,,,,,,,,,Other,2333.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2333.33,2333.33, PSN ASF PS 11MMPLY R 6-9 EF,C1776,HCPCS,278,RC,,,,both,2081.25,1456.88,,,,,,,,,,,,,,,,,,,Other,448.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.72,448.72, PSN ASF PS 10MMPLY R 6-9 EF,C1776,HCPCS,278,RC,,,,both,2081.25,1456.88,,,,,,,,,,,,,,,,,,,Other,448.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.72,448.72, BONE SCREW 6.5x30,C1713,HCPCS,278,RC,,,,both,233.1,163.17,,,,,,,,,,,,,,,,,,,Other,50.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.25,50.25, PSN ALL POLY PAT PLY 29MM,C1776,HCPCS,278,RC,,,,both,1082.25,757.58,,,,,,,,,,,,,,,,,,,Other,233.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,233.34,233.34, PSN ASF CPS 12MM VE R 3-5 CD,C1776,HCPCS,278,RC,,,,both,3546.45,2482.52,,,,,,,,,,,,,,,,,,,Other,764.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,764.62,764.62, "LEAD, NEUROSTIM TEST KIT",L8679,HCPCS,272,RC,,,,both,732.6,512.82,,,,,,,,,,,,,,,,,,,Other,157.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,157.95,157.95, INS NGRC-ECAPS MRI,C1820,HCPCS,278,RC,,,,both,66600,46620,,,,,,,,,,,,,,,,,,,Other,14358.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14358.96,14358.96, INCEPTIVE GENERATOR RECHARGER,L8689,HCPCS,274,RC,,,,both,4995,3496.5,,,,,,,,,,,,,,,,,,,Other,1076.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1076.92,1076.92, LEAD SPECIFY SURESCAN MRI 5-6-5,C1878,HCPCS,278,RC,,,,both,17649,12354.3,,,,,,,,,,,,,,,,,,,Other,3805.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3805.12,3805.12, INCENTIVE PATIENT REMOTE CASE,279,RC,,,,,,both,83.25,58.28,,,,,,,,,,,,,,,,,,,Other,17.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.95,17.95, INCENTIVE RECHARGER BELT,279,RC,,,,,,both,83.25,58.28,,,,,,,,,,,,,,,,,,,Other,17.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.95,17.95, TUNNELING TOOL,272,RC,,,,,,both,326.34,228.44,,,,,,,,,,,,,,,,,,,Other,70.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,70.35,70.35, INCEPTIVE SPINAL CORD STIMULATOR PATIEN,279,RC,,,,,,both,3996,2797.2,,,,,,,,,,,,,,,,,,,Other,861.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,861.54,861.54, SUB BIOPSY DEVICE 18G X 20CM,272,RC,,,,,,both,303.03,212.12,,,,,,,,,,,,,,,,,,,Other,65.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,65.34,65.34, "11MM,8DEG, 26/9 IBF",C1776,HCPCS,278,RC,,,,both,7659,5361.3,,,,,,,,,,,,,,,,,,,Other,1651.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1651.28,1651.28, PSN ASF PS 13MM VE L 6-9 EF,C1776,HCPCS,278,RC,,,,both,2081.25,1456.88,,,,,,,,,,,,,,,,,,,Other,448.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.72,448.72, TM PRIM FEM ST 15M,C1776,HCPCS,278,RC,,,,both,6905.75,4834.03,,,,,,,,,,,,,,,,,,,Other,1488.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1488.88,1488.88, PSN FEM PS CMT CCR NRW SZ11 R,C1776,HCPCS,278,RC,,,,both,5827.5,4079.25,,,,,,,,,,,,,,,,,,,Other,1256.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1256.41,1256.41, PSN ASF PS 14MM PLY R 10-12 EF,C1776,HCPCS,278,RC,,,,both,2081.25,1456.88,,,,,,,,,,,,,,,,,,,Other,448.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.72,448.72, NEEDLE ASPIRATION 5MM 16G 40CM,272,RC,,,,,,both,79.24,55.47,,,,,,,,,,,,,,,,,,,Other,17.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.08,17.08, OPTILUME 24FR KIT BASIC/DRUG BALLOON 3CM,C1889,HCPCS,278,RC,,,,both,11904.75,8333.33,,,,,,,,,,,,,,,,,,,Other,2566.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2566.67,2566.67, MINIONE BALLON BUTTON 18FR SIZE 4.0CM,272,RC,,,,,,both,439.56,307.69,,,,,,,,,,,,,,,,,,,Other,94.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,94.77,94.77, VERTAPLEX RADIOPAQUE BONE CEMENT,C1713,HCPCS,278,RC,,,,both,2683.98,1878.79,,,,,,,,,,,,,,,,,,,Other,578.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,578.67,578.67, TM PRIM STEM 11M STANDARD,C1776,HCPCS,278,RC,,,,both,6905.75,4834.03,,,,,,,,,,,,,,,,,,,Other,1488.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1488.88,1488.88, 3.5MM X48MM SCREW HEX,C1713,HCPCS,278,RC,,,,both,695.97,487.18,,,,,,,,,,,,,,,,,,,Other,150.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,150.05,150.05, PSN ASF PS 12MM PLY L 6-9 CD,C1776,HCPCS,278,RC,,,,both,2081.25,1456.88,,,,,,,,,,,,,,,,,,,Other,448.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.72,448.72, OPTILUME 24FR URETHAL CATH 5CM BALLOON,C1889,HCPCS,278,RC,,,,both,10839.15,7587.41,,,,,,,,,,,,,,,,,,,Other,2336.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2336.92,2336.92, OPTILUME 18 FR URETHAL CATH 5CM BALLON,C1889,HCPCS,278,RC,,,,both,10839.15,7587.41,,,,,,,,,,,,,,,,,,,Other,2336.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2336.92,2336.92, NEUROSTIMULATOR BOOT DISPOSABLE,279,RC,,,,,,both,166.5,116.55,,,,,,,,,,,,,,,,,,,Other,35.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.9,35.9, 1x8X40CM LOW IMPEDENCE EXTENSION KIT,C1883,HCPCS,278,RC,,,,both,2181.15,1526.81,,,,,,,,,,,,,,,,,,,Other,470.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,470.25,470.25, DRILL BIT FOR 3.5MM SCREW,272,RC,,,,,,both,416.25,291.38,,,,,,,,,,,,,,,,,,,Other,89.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,89.75,89.75, QUARTEX 3.5MMX16MM POLYAXIAL SCREW,C1713,HCPCS,278,RC,,,,both,2164.5,1515.15,,,,,,,,,,,,,,,,,,,Other,466.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,466.67,466.67, QUARTEX ROD 3.5MM X 80MM,C1713,HCPCS,278,RC,,,,both,566.1,396.27,,,,,,,,,,,,,,,,,,,Other,122.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,122.05,122.05, QUARTEX THREADED LOCKING CAP,C1776,HCPCS,278,RC,,,,both,166.5,116.55,,,,,,,,,,,,,,,,,,,Other,35.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.9,35.9, INCENTIVE RECHARGER BELT LARGE,279,RC,,,,,,both,83.25,58.28,,,,,,,,,,,,,,,,,,,Other,17.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.95,17.95, NV IPAS III DIAMOND SPRINGLESS PEDICLE A,272,RC,,,,,,both,932.4,652.68,,,,,,,,,,,,,,,,,,,Other,201.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,201.03,201.03, CREO MIS 5.5MM CURVED ROD 90MM,C1713,HCPCS,278,RC,,,,both,749.25,524.48,,,,,,,,,,,,,,,,,,,Other,161.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,161.54,161.54, MINIONE BUTTON 18FR SIZE 2.5CM,272,RC,,,,,,both,439.56,307.69,,,,,,,,,,,,,,,,,,,Other,94.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,94.77,94.77, SUB SOLUTION LACTATED RINGER 250 ML,J7120,HCPCS,258,RC,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.33,4.31, I FACTOR BONE GRAFT PUTTY 5.0CC,C1713,HCPCS,278,RC,,,,both,9324,6526.8,,,,,,,,,,,,,,,,,,,Other,2010.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2010.25,2010.25, PSN ASF PS 12MM PLY L 6-9 EF,C1776,HCPCS,278,RC,,,,both,2081.25,1456.88,,,,,,,,,,,,,,,,,,,Other,448.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.72,448.72, TM PRIM FEM ST 12MM,C1776,HCPCS,278,RC,,,,both,6909.75,4836.83,,,,,,,,,,,,,,,,,,,Other,1489.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1489.75,1489.75, PLASMA BAND 24 FR STANDARD 12/16 DEG,272,RC,,,,,,both,1774.47,1242.13,,,,,,,,,,,,,,,,,,,Other,382.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,382.57,382.57, MAS ALIF ACCESS KIT,C1713,HCPCS,278,RC,,,,both,4941.72,3459.2,,,,,,,,,,,,,,,,,,,Other,1065.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1065.44,1065.44, "INDEPENDENCE MIS SPACER, 26X34MM 8DEG",C1889,HCPCS,278,RC,,,,both,14985,10489.5,,,,,,,,,,,,,,,,,,,Other,3230.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3230.77,3230.77, "BONE SCREW, VARIABLE ANGLE 5.5MM, 30MM",C1713,HCPCS,278,RC,,,,both,1498.5,1048.95,,,,,,,,,,,,,,,,,,,Other,323.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,323.08,323.08, "BONE SCREW, FIXED ANGLE 5.5MM, 20MM",C1713,HCPCS,278,RC,,,,both,1485.18,1039.63,,,,,,,,,,,,,,,,,,,Other,320.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,320.21,320.21, OSSIFUSE HSA FIBER BONE GRAFT 5CC,C1713,HCPCS,278,RC,,,,both,2014.65,1410.26,,,,,,,,,,,,,,,,,,,Other,434.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,434.36,434.36, "INDEPENDENCE MIS SPACER, 24X30MM 8DEG",C1889,HCPCS,278,RC,,,,both,14985,10489.5,,,,,,,,,,,,,,,,,,,Other,3230.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3230.77,3230.77, "BONE SCREW, FIXEDANGLE 5.5MM, 25MM",C1713,HCPCS,278,RC,,,,both,1485.18,1039.63,,,,,,,,,,,,,,,,,,,Other,320.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,320.21,320.21, "BONE SCREW, VARIABLE ANGLE 5.5MM, 25MM",C1713,HCPCS,278,RC,,,,both,1498.5,1048.95,,,,,,,,,,,,,,,,,,,Other,323.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,323.08,323.08, "CERVICAL PEEK CAGE, 6X17X14 7 DEG",C1889,HCPCS,278,RC,,,,both,4995,3496.5,,,,,,,,,,,,,,,,,,,Other,1076.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1076.92,1076.92, CORENT SI SCREW 4X16 MM SELF TAP,C1713,HCPCS,278,RC,,,,both,399.6,279.72,,,,,,,,,,,,,,,,,,,Other,86.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,86.15,86.15, INCENTIVE RECHARGER BELT XL,279,RC,,,,,,both,83.25,58.28,,,,,,,,,,,,,,,,,,,Other,17.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.95,17.95, PATIENT TRIAL KIT,C1897,HCPCS,278,RC,,,,both,2164.5,1515.15,,,,,,,,,,,,,,,,,,,Other,466.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,466.67,466.67, CREO AMP 5.5X45MM MODULAR CANNULATED SCR,C1713,HCPCS,278,RC,,,,both,1498.5,1048.95,,,,,,,,,,,,,,,,,,,Other,323.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,323.08,323.08, "HEDRON P SPACER 8X22, 7MM 4 DEG",C1889,HCPCS,278,RC,,,,both,11655,8158.5,,,,,,,,,,,,,,,,,,,Other,2512.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2512.82,2512.82, REPROC LIGASURE SMALL JAW,272,RC,,,,,,both,1008.36,705.85,,,,,,,,,,,,,,,,,,,Other,217.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,217.4,217.4, TRILOGY MODULAR CUP NEUTRAL 56X36,C1776,HCPCS,278,RC,,,,both,2664,1864.8,,,,,,,,,,,,,,,,,,,Other,574.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,574.36,574.36, TRILOGY ACET SHELL 56MM OD CLUSTER,C1776,HCPCS,278,RC,,,,both,2863.8,2004.66,,,,,,,,,,,,,,,,,,,Other,617.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,617.44,617.44, "HEDRON P SPACER 10X22, 12MM 8 DEG",C1889,HCPCS,278,RC,,,,both,11655,8158.5,,,,,,,,,,,,,,,,,,,Other,2512.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2512.82,2512.82, "HEDRON P SPACER 10X22, 8MM 8 DEG",C1889,HCPCS,278,RC,,,,both,11655,8158.5,,,,,,,,,,,,,,,,,,,Other,2512.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2512.82,2512.82, VIABAHN SX ENDO HEPARIN 18RO/8MMX10CM 7F,C1874,HCPCS,278,RC,,,,both,12297.69,8608.38,,,,,,,,,,,,,,,,,,,Other,2651.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2651.38,2651.38, Z NAIL CPM 10.5MM X 38CM 130L,C1713,HCPCS,278,RC,,,,both,7161.2,5012.84,,,,,,,,,,,,,,,,,,,Other,1543.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1543.95,1543.95, Z NAIL 5.0X45 CORT SCREW FA,C1713,HCPCS,278,RC,,,,both,620.81,434.57,,,,,,,,,,,,,,,,,,,Other,133.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,133.85,133.85, "PRECEPT NIT K-WIRE, BEVEL TIP",272,RC,,,,,,both,166.5,116.55,,,,,,,,,,,,,,,,,,,Other,35.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.9,35.9, OSSIFUSE FLOWABLE FIBER BONE GRAFT PUTTY,C1713,HCPCS,278,RC,,,,both,2014.65,1410.26,,,,,,,,,,,,,,,,,,,Other,434.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,434.36,434.36, VERSYS DISTAL CENTRALIZER 10MM,C1776,HCPCS,278,RC,,,,both,183.15,128.21,,,,,,,,,,,,,,,,,,,Other,39.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.48,39.48, VERSYS HERITAGE FEM STEM 13X130MM,C1776,HCPCS,278,RC,,,,both,4212.45,2948.72,,,,,,,,,,,,,,,,,,,Other,908.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,908.21,908.21, SCREW 2.4 LOCKING 1.5MM 24MM,C1713,HCPCS,278,RC,,,,both,275.79,193.05,,,,,,,,,,,,,,,,,,,Other,59.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,59.46,59.46, K-WIRE .28X6 DBL TRO 6PK NS,272,RC,,,,,,both,231.63,162.14,,,,,,,,,,,,,,,,,,,Other,49.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,49.94,49.94, FAST 1.1MM DRILL BIT MINIQUICK,272,RC,,,,,,both,164.8,115.36,,,,,,,,,,,,,,,,,,,Other,35.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.53,35.53, SCREW 2.4 LOCKING 1.5MM 22MM,C1713,HCPCS,278,RC,,,,both,275.79,193.05,,,,,,,,,,,,,,,,,,,Other,59.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,59.46,59.46, "INDEPENDENCE MIS SPACER, 24X30MM 15DEG 1",C1889,HCPCS,278,RC,,,,both,14985,10489.5,,,,,,,,,,,,,,,,,,,Other,3230.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3230.77,3230.77, "SELF DRILLING SCREW, VARIABLE ANGLE 5.5M",C1713,HCPCS,278,RC,,,,both,1498.5,1048.95,,,,,,,,,,,,,,,,,,,Other,323.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,323.08,323.08, CATH ANGIOGRAPHIC 4FR 65CM 1CM TIP STRAI,C1757,HCPCS,272,RC,,,,both,108.24,75.77,,,,,,,,,,,,,,,,,,,Other,23.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.33,23.33, "BONE SCREW, VARIABLE ANGLE 5.5MM, 40MM",C1713,HCPCS,278,RC,,,,both,1498.5,1048.95,,,,,,,,,,,,,,,,,,,Other,323.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,323.08,323.08, "ELSA SPACER 20 X 60MM, 8-15MM, 6 DEG.",C1889,HCPCS,278,RC,,,,both,36536.76,25575.73,,,,,,,,,,,,,,,,,,,Other,7877.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7877.33,7877.33, "NVM5 NEEDLE MODULE, EMG",272,RC,,,,,,both,2664,1864.8,,,,,,,,,,,,,,,,,,,Other,574.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,574.36,574.36, "DISC SHIM, ALUMINUM",C1889,HCPCS,278,RC,,,,both,1851.48,1296.04,,,,,,,,,,,,,,,,,,,Other,399.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,399.18,399.18, "NVM5 XLIF DILATOR KIT, STERILE",272,RC,,,,,,both,2331,1631.7,,,,,,,,,,,,,,,,,,,Other,502.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,502.56,502.56, ASCOPE 5 DISPOSABLE URETEROSCOPE AMBU,C1747,HCPCS,278,RC,,,,both,2747.25,1923.08,,,,,,,,,,,,,,,,,,,Other,592.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,592.31,592.31, PSN ASF PS 11MM PLY R 10-111 EF,C1776,HCPCS,278,RC,,,,both,2081.25,1456.88,,,,,,,,,,,,,,,,,,,Other,448.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.72,448.72, PSN ALL POLY PAT PLY 32MM,C1776,HCPCS,278,RC,,,,both,1082.25,757.58,,,,,,,,,,,,,,,,,,,Other,233.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,233.34,233.34, "INDEPENDENCE MIS SPACER, 26X34MM 15DEG.",C1889,HCPCS,278,RC,,,,both,14152.5,9906.75,,,,,,,,,,,,,,,,,,,Other,3051.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3051.28,3051.28, TRILOGY ACET SHELL 60MM OD CLUSTER,C1776,HCPCS,278,RC,,,,both,2863.8,2004.66,,,,,,,,,,,,,,,,,,,Other,617.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,617.44,617.44, MODULAR CUP 10 DEG LINER LONGEVITY 60X36,C1776,HCPCS,278,RC,,,,both,2664,1864.8,,,,,,,,,,,,,,,,,,,Other,574.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,574.36,574.36, OSSIFUSE HSA FIBER BONE GRAFT 10CC,C1713,HCPCS,278,RC,,,,both,3796.2,2657.34,,,,,,,,,,,,,,,,,,,Other,818.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,818.46,818.46, CREO AMP 7.5x50mm MOD CANNULATED SCREW,C1713,HCPCS,278,RC,,,,both,1498.5,1048.95,,,,,,,,,,,,,,,,,,,Other,323.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,323.08,323.08, "RELINE MAS NITINOL K-WIRE, BLUNT",272,RC,,,,,,both,166.5,116.55,,,,,,,,,,,,,,,,,,,Other,35.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.9,35.9, "AEROGEN ULTRA, ADAPTER (NO O2 TUBING)",272,RC,,,,,,both,31.97,22.38,,,,,,,,,,,,,,,,,,,Other,6.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.89,6.89, "AEROGEN SOLO, NEBULIZER KIT 15ML",272,RC,,,,,,both,184.66,129.26,,,,,,,,,,,,,,,,,,,Other,39.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.82,39.82, "BONE SCREW, VARIABLE ANGLE 5.5MM, 20MM",C1713,HCPCS,278,RC,,,,both,1498.5,1048.95,,,,,,,,,,,,,,,,,,,Other,323.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,323.08,323.08, 6.5MM CANNULATED SCREW 16MM THD 85MM,C1713,HCPCS,278,RC,,,,both,721.08,504.76,,,,,,,,,,,,,,,,,,,Other,155.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,155.47,155.47, WASHER FOR 5.5MM THRU 7.5MM CANULATED SC,272,RC,,,,,,both,152.89,107.02,,,,,,,,,,,,,,,,,,,Other,32.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.97,32.97, INFUSE BONE GRAFT KIT XSMALL,C1713,HCPCS,278,RC,,,,both,7812.18,5468.53,,,,,,,,,,,,,,,,,,,Other,1684.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1684.31,1684.31, INFUSE BONE GRAFT KIT SMALL,C1713,HCPCS,278,RC,,,,both,15521.13,10864.79,,,,,,,,,,,,,,,,,,,Other,3346.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3346.36,3346.36, INFUSE BONE GRAFT KIT MEDIUM,C1713,HCPCS,278,RC,,,,both,21248.73,14874.11,,,,,,,,,,,,,,,,,,,Other,4581.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4581.23,4581.23, INFUSE BONE GRAFT KIT LARGE,C1713,HCPCS,278,RC,,,,both,23659.65,16561.76,,,,,,,,,,,,,,,,,,,Other,5101.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5101.02,5101.02, INFUSE BONE GRAFT KIT XLARGE,C1713,HCPCS,278,RC,,,,both,23659.65,16561.76,,,,,,,,,,,,,,,,,,,Other,5101.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5101.02,5101.02, MESH ENFORM 20CMX25CM,C1781,HCPCS,278,RC,,,,both,31102.2,21771.54,,,,,,,,,,,,,,,,,,,Other,6705.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6705.63,6705.63, MESH ENFORM 25CMX40CM,C1781,HCPCS,278,RC,,,,both,62187.75,43531.43,,,,,,,,,,,,,,,,,,,Other,13407.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13407.68,13407.68, "ALTERA SPACER, 10X26, 10-14MM, 8 DEG",C1889,HCPCS,278,RC,,,,both,14985,10489.5,,,,,,,,,,,,,,,,,,,Other,3230.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3230.77,3230.77, "BIOLOX DELTA FEM HEAD, 28MM, +0MM",C1776,HCPCS,278,RC,,,,both,2486.68,1740.68,,,,,,,,,,,,,,,,,,,Other,536.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,536.13,536.13, RINGLOC BIPOLAR ACETABULAR CUP,278,RC,,,,,,both,1465.2,1025.64,,,,,,,,,,,,,,,,,,,Other,315.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,315.89,315.89, PSN ASF PS 12MM PLY L 10-12 GH,C1776,HCPCS,278,RC,,,,both,2081.25,1456.88,,,,,,,,,,,,,,,,,,,Other,448.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.72,448.72, PSN ASF PS 10MM PLY L 10-12 EF,C1776,HCPCS,278,RC,,,,both,2081.25,1456.88,,,,,,,,,,,,,,,,,,,Other,448.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.72,448.72, PORT-A-CATH II SINGLE-LUMEN 1.6MM 8.5FR,272,RC,,,,,,both,1047.65,733.36,,,,,,,,,,,,,,,,,,,Other,225.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,225.87,225.87, PORT-A-CATH II LOW PROFILE 1.6MM 8.5FR,272,RC,,,,,,both,1023.98,716.79,,,,,,,,,,,,,,,,,,,Other,220.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,220.77,220.77, PORT-A-CATH II LOW PROFILE 1.0MM 6FR,272,RC,,,,,,both,1047.65,733.36,,,,,,,,,,,,,,,,,,,Other,225.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,225.87,225.87, PRESTIGE LP CERVICAL DISC 6MM X18MM,L8699,HCPCS,278,RC,,,,both,14152.5,9906.75,,,,,,,,,,,,,,,,,,,Other,3051.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3051.28,3051.28, SERFAS ENERGY 4MM X135MM 90 DEG,272,RC,,,,,,both,532.8,372.96,,,,,,,,,,,,,,,,,,,Other,114.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,114.88,114.88, CATH PIGTAIL DRAINAGE 6FR 25CM,C1887,HCPCS,272,RC,,,,both,283.05,198.14,,,,,,,,,,,,,,,,,,,Other,61.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.02,61.02, CATH PIGTAIL DRAINAGE 8FR 25CM,C1887,HCPCS,272,RC,,,,both,283.05,198.14,,,,,,,,,,,,,,,,,,,Other,61.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.02,61.02, CATH PIGTAIL DRAINAGE 10FR 25CM,C1887,HCPCS,272,RC,,,,both,283.05,198.14,,,,,,,,,,,,,,,,,,,Other,61.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.02,61.02, CATH PIGTAIL DRAINAGE 12FR 25CM,C1887,HCPCS,272,RC,,,,both,283.05,198.14,,,,,,,,,,,,,,,,,,,Other,61.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.02,61.02, CATH PIGTAIL DRAINAGE 14FR 25CM,C1887,HCPCS,272,RC,,,,both,283.05,198.14,,,,,,,,,,,,,,,,,,,Other,61.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.02,61.02, INVENGENX BOVINE PERICARDIAL PATCH 5CMX1,C1768,HCPCS,278,RC,,,,both,1175.49,822.84,,,,,,,,,,,,,,,,,,,Other,253.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,253.44,253.44, MAS TLIF KIT,C1713,HCPCS,278,RC,,,,both,3165.17,2215.62,,,,,,,,,,,,,,,,,,,Other,682.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,682.41,682.41, "SUTURE 3-0 POLYSORB UNDYED 1X30"" V-20",272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, "INDEPENDENCE MIS SPACER, 26X34MM 8DEG, 1",C1889,HCPCS,278,RC,,,,both,14152.5,9906.75,,,,,,,,,,,,,,,,,,,Other,3051.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3051.28,3051.28, NEEDLE EBUS-TBNA VIZISHOT 21 G/70CM,C2613,HCPCS,278,RC,,,,both,832.17,582.52,,,,,,,,,,,,,,,,,,,Other,179.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,179.42,179.42, TUBE FEEDING 18FR 7-10ML BALLON ADULT,272,RC,,,,,,both,152.89,107.02,,,,,,,,,,,,,,,,,,,Other,32.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.97,32.97, PARIETENE 45X30CM NONABSORABLE PLYPROPLY,C1781,HCPCS,278,RC,,,,both,748.38,523.87,,,,,,,,,,,,,,,,,,,Other,161.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,161.35,161.35, PASSER CATHETER 38CM,C1769,HCPCS,272,RC,,,,both,326.34,228.44,,,,,,,,,,,,,,,,,,,Other,70.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,70.35,70.35, "ELSA SPACER 20 X 50MM, 8-15MM, 6DEG.",C1889,HCPCS,278,RC,,,,both,36536.76,25575.73,,,,,,,,,,,,,,,,,,,Other,7877.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7877.33,7877.33, PSN ALL POLY PAT PLY 41 MM DIA,C1776,HCPCS,278,RC,,,,both,1082.25,757.58,,,,,,,,,,,,,,,,,,,Other,233.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,233.34,233.34, Z NAIL RF 11.5MMX42CM UNIV,C1776,HCPCS,278,RC,,,,both,7161.98,5013.39,,,,,,,,,,,,,,,,,,,Other,1544.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1544.13,1544.13, Z NAIL 5.0X55 CORT SCREW FA,C1713,HCPCS,278,RC,,,,both,620.81,434.57,,,,,,,,,,,,,,,,,,,Other,133.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,133.85,133.85, VERSYS HERITAGE FEM STEM 14X135MM,C1776,HCPCS,278,RC,,,,both,4212.45,2948.72,,,,,,,,,,,,,,,,,,,Other,908.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,908.21,908.21, VERSYS DISTAL CENTRALIZER 13MM,C1776,HCPCS,278,RC,,,,both,183.15,128.21,,,,,,,,,,,,,,,,,,,Other,39.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.48,39.48, PREP IM ENHANCE TOTAL HIP KIT,279,RC,,,,,,both,4142.52,2899.76,,,,,,,,,,,,,,,,,,,Other,893.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,893.12,893.12, SUTURE 2-0 POLYSORB GS-21 CL-953,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE TICRON 0 CV-305,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 2-0 SOFSILK V-20 GS8-333,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE MAXON 1 1X60 GS-26,272,RC,,,,,,both,29.73,20.81,,,,,,,,,,,,,,,,,,,Other,6.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.41,6.41, VIABAHN BX BALLON EXP ENDO/8MMX79MM 7FR1,C1874,HCPCS,278,RC,,,,both,12204.45,8543.12,,,,,,,,,,,,,,,,,,,Other,2631.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2631.28,2631.28, CODA ACP 2 LEVEL PLATE 28MM,C1713,HCPCS,278,RC,,,,both,1998,1398.6,,,,,,,,,,,,,,,,,,,Other,430.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,430.77,430.77, CREO MIS 5.5X50MM STRAIGHT ROD TITANIUM,C1713,HCPCS,278,RC,,,,both,749.25,524.48,,,,,,,,,,,,,,,,,,,Other,161.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,161.54,161.54, LUTONIX 018 4X100 4F,C1725,HCPCS,278,RC,,,,both,6516.81,4561.77,,,,,,,,,,,,,,,,,,,Other,1405.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1405.03,1405.03, SUTURE 2-0 POLYSORB V-20,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 2-0 POLYSORB DTACH GS-21,272,RC,,,,,,both,39.03,27.32,,,,,,,,,,,,,,,,,,,Other,8.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.42,8.42, "SUTURE POLYSORB TIES 18""",272,RC,,,,,,both,37.72,26.4,,,,,,,,,,,,,,,,,,,Other,8.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.13,8.13, SUTURE 4-0 SURGIPRO II CV-23,272,RC,,,,,,both,22.39,15.67,,,,,,,,,,,,,,,,,,,Other,4.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.83,4.83, SUTURE #1 TICRON BLUE GS-21,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 4-0 BIOSYN P-12,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 3-0 BIOSYN UNDYED P-14,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 5-0 SURGILON BLACK P-13,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 3-0 SOFSILK D-TACH V-20,272,RC,,,,,,both,23.25,16.28,,,,,,,,,,,,,,,,,,,Other,5.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.02,5.02, "CRYSTAL CANNULA, PARTIALLY THREADED",C1713,HCPCS,278,RC,,,,both,112.75,78.93,,,,,,,,,,,,,,,,,,,Other,24.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.31,24.31, HD SCORPION NEEDLE,272,RC,,,,,,both,714.29,500,,,,,,,,,,,,,,,,,,,Other,154,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,154,154, SUTURE ANCHOR CORKSSREW 5X15.5MM,272,RC,,,,,,both,714.29,500,,,,,,,,,,,,,,,,,,,Other,154,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,154,154, SWVLK TENO BIO-COMP 7X19.5MM,272,RC,,,,,,both,1593.41,1115.39,,,,,,,,,,,,,,,,,,,Other,343.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,343.54,343.54, "REAMER PILOTED HEADED, 7.5MM",A4649,HCPCS,272,RC,,,,both,750.92,525.64,,,,,,,,,,,,,,,,,,,Other,161.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,161.9,161.9, SUTURE TAPE 1.3MM 2.2 CRVD 26.5MM NDLS,C1713,HCPCS,278,RC,,,,both,248.95,174.27,,,,,,,,,,,,,,,,,,,Other,53.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,53.67,53.67, PARIETENE DS 12 CM,C1781,HCPCS,278,RC,,,,both,1366.99,956.89,,,,,,,,,,,,,,,,,,,Other,294.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,294.73,294.73, PARIETENE DS 15CM,C1781,HCPCS,278,RC,,,,both,1842.92,1290.04,,,,,,,,,,,,,,,,,,,Other,397.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,397.33,397.33, MAXTACK MOTORIZED STRAIGHT FIXN DEVICE,272,RC,,,,,,both,1983.08,1388.16,,,,,,,,,,,,,,,,,,,Other,427.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,427.55,427.55, PARIETENE MACROPORUS MESH 15X15CM,C1781,HCPCS,278,RC,,,,both,204.75,143.33,,,,,,,,,,,,,,,,,,,Other,44.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.15,44.15, SUTURE 3-0 POLYSORB V-20 D TACH,272,RC,,,,,,both,34.24,23.97,,,,,,,,,,,,,,,,,,,Other,7.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.38,7.38, SUTURE 5-0 POLYSORB UNDYED CV-22,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 2-0 SOFTSILK C-15,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 5-0 BIOSYN UNDYED P-13,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 3-0 SURGIPRO II V-20,272,RC,,,,,,both,29.73,20.81,,,,,,,,,,,,,,,,,,,Other,6.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.41,6.41, SUTURE 3-0 MONOSOF C-14,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 2-0 MONOSOF C-15,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 2-0 SURGIPRO BLUE V-20,272,RC,,,,,,both,29.73,20.81,,,,,,,,,,,,,,,,,,,Other,6.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.41,6.41, SUTURE 4-0 BIOSYN UNDYED DX-16,272,RC,,,,,,both,22.47,15.73,,,,,,,,,,,,,,,,,,,Other,4.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.84,4.84, SUTURE 4-0 MONOSOF C-13,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 4-0 SURGIPRO II C-13,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 4-0 POLYSORB UNDYED CV-23,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 0 POLYSORB VIOLET GU-46,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, MESH PARIETEX 8.6 CM VENTRAL PATCH,C1781,HCPCS,278,RC,,,,both,1766.93,1236.85,,,,,,,,,,,,,,,,,,,Other,380.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,380.95,380.95, PSN TPR ST 14X30+30MM,C1776,HCPCS,278,RC,,,,both,3280.05,2296.04,,,,,,,,,,,,,,,,,,,Other,707.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,707.18,707.18, PSN ASF PS 12MM PLY R 10-12 GH,C1776,HCPCS,278,RC,,,,both,2081.25,1456.88,,,,,,,,,,,,,,,,,,,Other,448.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.72,448.72, SUTURE 5-0 SURGIPRO P-13,272,RC,,,,,,both,20.4,14.28,,,,,,,,,,,,,,,,,,,Other,4.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.4,4.4, SUTURE 4-0 SURGIPRO P-12,272,RC,,,,,,both,20.4,14.28,,,,,,,,,,,,,,,,,,,Other,4.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.4,4.4, PARIETENE DS 25CMx20CM,C1781,HCPCS,278,RC,,,,both,3088.81,2162.17,,,,,,,,,,,,,,,,,,,Other,665.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,665.95,665.95, MESH PARIETENE DS 20CMx15CM,C1781,HCPCS,278,RC,,,,both,1993.57,1395.5,,,,,,,,,,,,,,,,,,,Other,429.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,429.82,429.82, SUTURE 4-0 MONOSOF P-13,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, "SUTURE MAXON 0 1X30"" GS-22",272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 3-0 MAXON V-20,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 2-0 SOFSILK PRE-CUT,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 2-0 SOFSILK CV-15,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 0 POLYSORB GS-21 UNDYED,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 5-0 MONOSOF C-13 BLACK,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 5-0 MONOSOF P-13 BLACK,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, PSN FEM PS CMT CCR STD SZ 6R,C1776,HCPCS,278,RC,,,,both,5827.5,4079.25,,,,,,,,,,,,,,,,,,,Other,1256.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1256.41,1256.41, PSN ASF PS 13MMPLY R 6-9 CD,C1776,HCPCS,278,RC,,,,both,2081.25,1456.88,,,,,,,,,,,,,,,,,,,Other,448.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.72,448.72, PSN FEM PS CMT CCR NRW SZ 10 R,C1776,HCPCS,278,RC,,,,both,5827.5,4079.25,,,,,,,,,,,,,,,,,,,Other,1256.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1256.41,1256.41, PSN ASF PS 12MMPLY R 10-11 EF,C1776,HCPCS,278,RC,,,,both,2081.25,1456.88,,,,,,,,,,,,,,,,,,,Other,448.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.72,448.72, "DURA RO 5MM BRUSH ATCH, 25MM, 180MM",272,RC,,,,,,both,2497.5,1748.25,,,,,,,,,,,,,,,,,,,Other,538.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,538.46,538.46, "DURAPRO 3MM BARREL ATTCH, 22MM, 140 MM",272,RC,,,,,,both,1998,1398.6,,,,,,,,,,,,,,,,,,,Other,430.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,430.77,430.77, INCENTIVE RECHARGER BELT MEDIUM,279,RC,,,,,,both,83.25,58.28,,,,,,,,,,,,,,,,,,,Other,17.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.95,17.95, LEAD SPECIFY SURESCAN MRI 2X8,C1878,HCPCS,278,RC,,,,both,17649,12354.3,,,,,,,,,,,,,,,,,,,Other,3805.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3805.12,3805.12, SUTURE 3-0 SOFSILK V-20 D-TACH,272,RC,,,,,,both,23.48,16.44,,,,,,,,,,,,,,,,,,,Other,5.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.07,5.07, "SUTURE 4-0 SOFSILK 18"" TIES USUS-193",272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, "DURAPRO 5MM BRUSH ATT, 22MM, 180CM, DEMO",272,RC,,,,,,both,2497.5,1748.25,,,,,,,,,,,,,,,,,,,Other,538.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,538.46,538.46, PSN ASF PS 12MM PLY R 6-9 EF,C1776,HCPCS,278,RC,,,,both,2081.25,1456.88,,,,,,,,,,,,,,,,,,,Other,448.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.72,448.72, "HEDRON P SPACER 10X26, 10MM 8 DEG",C1889,HCPCS,278,RC,,,,both,11655,8158.5,,,,,,,,,,,,,,,,,,,Other,2512.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2512.82,2512.82, SUTURE 5-0 SURGIPRO CV-11 DBL ARMED,272,RC,,,,,,both,30.02,21.01,,,,,,,,,,,,,,,,,,,Other,6.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.47,6.47, SUTURE 6-0 SURGIPRO II CV-1,272,RC,,,,,,both,30.02,21.01,,,,,,,,,,,,,,,,,,,Other,6.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.47,6.47, SUTURE 7-0 SURGIPRO II CV-1,272,RC,,,,,,both,45.97,32.18,,,,,,,,,,,,,,,,,,,Other,9.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.91,9.91, "SUTURE 3-0 SOFSILK 12X18"" PRE-CUT",272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 2-0 BIOSYN UNDYED GS-21,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 4-0 SURGIPRO II CV-23,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SUTURE 5-0 SURGIPRO CV-11 SINGLE ARMED,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, "MODULUS ALIF BOLT, 5.0X20MM FIXATION",C1713,HCPCS,278,RC,,,,both,999,699.3,,,,,,,,,,,,,,,,,,,Other,215.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,215.38,215.38, "MODULUS ALIF BOLT, 5.0X17.5MM FIXATION",C1713,HCPCS,278,RC,,,,both,999,699.3,,,,,,,,,,,,,,,,,,,Other,215.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,215.38,215.38, "MODULUS ALIF, 6X34X24MM 15",C1889,HCPCS,278,RC,,,,both,14985,10489.5,,,,,,,,,,,,,,,,,,,Other,3230.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3230.77,3230.77, SUTURE 6-0 MONOSOF C-1,272,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, "SABLE SPACER, 10 X 30, 10-17 MM, 15 DEG",C1889,HCPCS,278,RC,,,,both,19980,13986,,,,,,,,,,,,,,,,,,,Other,4307.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4307.69,4307.69, PSN ASF PS 10MM PLY L 6-9 CD,C1776,HCPCS,278,RC,,,,both,2081.25,1456.88,,,,,,,,,,,,,,,,,,,Other,448.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.72,448.72, NCB CANCEL SCREW 5.0 32 L50,278,RC,,,,,,both,443.43,310.4,,,,,,,,,,,,,,,,,,,Other,95.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,95.6,95.6, NCB CANCEL SCREW 5.0 32 L75,278,RC,,,,,,both,443.43,310.4,,,,,,,,,,,,,,,,,,,Other,95.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,95.6,95.6, NCB CANCEL SCREW 5.0 32 L70,278,RC,,,,,,both,443.43,310.4,,,,,,,,,,,,,,,,,,,Other,95.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,95.6,95.6, NCB SCREW 5.0 L=36,278,RC,,,,,,both,521.05,364.74,,,,,,,,,,,,,,,,,,,Other,112.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,112.34,112.34, NCB SCREW 5.0 L=30,278,RC,,,,,,both,521.05,364.74,,,,,,,,,,,,,,,,,,,Other,112.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,112.34,112.34, NCB SCREW 5.0 L=28,278,RC,,,,,,both,521.05,364.74,,,,,,,,,,,,,,,,,,,Other,112.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,112.34,112.34, "NCB DRILL BIT 4.3MM,L. 145MM",272,RC,,,,,,both,321.51,225.06,,,,,,,,,,,,,,,,,,,Other,69.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,69.32,69.32, NCB PLATE FOR FEMUR LEFT 9 HOLE,C1713,HCPCS,278,RC,,,,both,4434.16,3103.91,,,,,,,,,,,,,,,,,,,Other,956.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,956.01,956.01, "HEDRON P SPACER 10X26, 9MM 8 DEG",C1889,HCPCS,278,RC,,,,both,11655,8158.5,,,,,,,,,,,,,,,,,,,Other,2512.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2512.82,2512.82, PSN ASF PS 11MM PLY L 6-9 CD,C1776,HCPCS,278,RC,,,,both,2081.25,1456.88,,,,,,,,,,,,,,,,,,,Other,448.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,448.72,448.72, "HEDRON P SPACER 10X30, 9MM 8 DEG",C1889,HCPCS,278,RC,,,,both,11655,8158.5,,,,,,,,,,,,,,,,,,,Other,2512.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2512.82,2512.82, "INDEPENDENCE MIS SPACER, 26X34MM 8DEG, 1",C1889,HCPCS,278,RC,,,,both,14985,10489.5,,,,,,,,,,,,,,,,,,,Other,3230.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3230.77,3230.77, "BONE SCREW, VARIABLE ANGLE 5.5MM, 35MM",C1713,HCPCS,278,RC,,,,both,450,315,,,,,,,,,,,,,,,,,,,Other,97.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,97.02,97.02, TUMARK MARKER VISION 127.5MM,A4648,HCPCS,278,RC,,,,both,266.4,186.48,,,,,,,,,,,,,,,,,,,Other,57.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,57.44,57.44, TUMARK MARKER CONIC 120MM 18GA,A4648,HCPCS,278,RC,,,,both,307.03,214.92,,,,,,,,,,,,,,,,,,,Other,66.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,66.2,66.2, DVR LOCK NARROW MINI R,C1713,HCPCS,278,RC,,,,both,2754.54,1928.18,,,,,,,,,,,,,,,,,,,Other,593.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,593.88,593.88, LOCK SCREW SQUARE 2.7MM 26MM,C1713,HCPCS,278,RC,,,,both,369.96,258.97,,,,,,,,,,,,,,,,,,,Other,79.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,79.76,79.76, PSN ASF PS 11MM VE L 10-11 EF,C1776,HCPCS,278,RC,,,,both,2830.05,1981.04,,,,,,,,,,,,,,,,,,,Other,610.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.16,610.16, VIABAHN SX ENDO HEPARIN 18 RO 7MMX 25CM,C1874,HCPCS,278,RC,,,,both,22733.91,15913.74,,,,,,,,,,,,,,,,,,,Other,4901.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4901.43,4901.43, VIABAHN SX ENDO HEPARIN 18 RO 7MMX10CM 7,C1874,HCPCS,278,RC,,,,both,12297.69,8608.38,,,,,,,,,,,,,,,,,,,Other,2651.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2651.38,2651.38, NEEDLE BIOPSY BREVERA 9GX13CM,272,RC,,,,,,both,799.2,559.44,,,,,,,,,,,,,,,,,,,Other,172.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,172.3,172.3, PSN ASF PS 11MM VE R 10-11 EF,278,RC,,,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,610.26,610.26, OSSIFUSE FILLER FIBER BONE GRAFT PUTTY,C1713,HCPCS,278,RC,,,,both,3729.6,2610.72,,,,,,,,,,,,,,,,,,,Other,804.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,804.1,804.1, CREO MIS 5.5X95MM CURVED ROD TITANIUM,C1713,HCPCS,278,RC,,,,both,749.25,524.48,,,,,,,,,,,,,,,,,,,Other,161.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,161.54,161.54, CLEARPETRA URETERAL SHEATH 12/14 FR x36,C9761,HCPCS,272,RC,,,,both,2497.5,1748.25,,,,,,,,,,,,,,,,,,,Other,538.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,538.46,538.46, CLEARPETRA STONE COLLECTION BOTTLE,272,RC,,,,,,both,172.61,120.83,,,,,,,,,,,,,,,,,,,Other,37.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.21,37.21, STAPLER INTERNAL GIA 80MM,272,RC,,,,,,both,531.4,371.98,,,,,,,,,,,,,,,,,,,Other,114.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,114.57,114.57, ENDO GIA 80MM RELOAD,272,RC,,,,,,both,277.06,193.94,,,,,,,,,,,,,,,,,,,Other,59.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,59.73,59.73, STAPLER EEA 25MM,272,RC,,,,,,both,1355.91,949.14,,,,,,,,,,,,,,,,,,,Other,292.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,292.33,292.33, CLEARPETRA URETHERAL SHEATH 11/13 FR x36,C9761,HCPCS,360,RC,,,,both,1581.75,1107.23,,,,,,,,,,,,,,,,,,,Other,341.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,341.03,341.03, CLEARPETRA URETHERAL SHEATH 11/13 FR x46,C9761,HCPCS,360,RC,,,,both,1581.75,1107.23,,,,,,,,,,,,,,,,,,,Other,341.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,341.03,341.03, CLEARPETRA URETHERAL SHEATH 12/14 FR x46,C9761,HCPCS,360,RC,,,,both,1581.75,1107.23,,,,,,,,,,,,,,,,,,,Other,341.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,341.03,341.03, SAVISCOUT 10CM DELIVERY NEEDLE/REFLECTOR,A4648,HCPCS,278,RC,,,,both,1681.65,1177.16,,,,,,,,,,,,,,,,,,,Other,362.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,362.56,362.56, "DURA RO 5MM BRUSH ATCH, 15MM, 180MM",272,RC,,,,,,both,2497.5,1748.25,,,,,,,,,,,,,,,,,,,Other,538.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,538.46,538.46, "DURAPRO 5MM BALL ATCH, 22MM,140MM",272,RC,,,,,,both,1998,1398.6,,,,,,,,,,,,,,,,,,,Other,430.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,430.77,430.77, "DURA RO 5MM BRUSH ATCH, 15MM, 180MM",272,RC,,,,,,both,2497.5,1748.25,,,,,,,,,,,,,,,,,,,Other,538.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,538.46,538.46, NEEDLE KEITH ABDOMINAL 2.75 TRIPOINT,272,RC,,,,,,both,41.66,29.16,,,,,,,,,,,,,,,,,,,Other,8.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.99,8.99, SUTURE 4-0 ETHIBOND PS-4,272,RC,,,,,,both,20.95,14.67,,,,,,,,,,,,,,,,,,,Other,4.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.52,4.52, SUTURE 3-0 ETHIBOND V-5 DBL ARM,272,RC,,,,,,both,29.52,20.66,,,,,,,,,,,,,,,,,,,Other,6.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.36,6.36, "K-WIRE .062X9"" DBL TROCAR SMOOTH",272,RC,,,,,,both,24.15,16.91,,,,,,,,,,,,,,,,,,,Other,5.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.2,5.2, BLADE HYPERANGLE S3 GS SPECTRUM QC,272,RC,,,,,,both,165.96,116.17,,,,,,,,,,,,,,,,,,,Other,35.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.78,35.78, BLADE HYPERANGLE S4 GS SPECTRUM QC,272,RC,,,,,,both,165.96,116.17,,,,,,,,,,,,,,,,,,,Other,35.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.78,35.78, CATH ANGIO SOFT-VU 4FR 80CM,272,RC,,,,,,both,108.24,75.77,,,,,,,,,,,,,,,,,,,Other,23.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.33,23.33, LUTONIX 018 DCB 5FR 130CM 5X40MM,C1725,HCPCS,278,RC,,,,both,6516.81,4561.77,,,,,,,,,,,,,,,,,,,Other,1405.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1405.03,1405.03, PRESTIGE (R) LP CERIVICAL DISC 6x16MM,L8699,HCPCS,278,RC,,,,both,14152.5,9906.75,,,,,,,,,,,,,,,,,,,Other,3051.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3051.28,3051.28, BLADE HYPERANGLE S3 GS SPECTRUM QC,272,RC,,,,,,both,165.96,116.17,,,,,,,,,,,,,,,,,,,Other,35.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.78,35.78, "POWERFLEX TAPE 1.5"" WHITE",71,RC,,,,,,both,32.99,23.09,,,,,,,,,,,,,,,,,,,Other,7.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.11,7.11, 2ND ADDL LEVEL SPINE INJ,360,RC,,,,,,both,985.07,689.55,,,,,,,,,,,,,,,,,,,Other,212.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,212.39,212.39, 3RD ADDL LEVEL SPINE INJ,360,RC,,,,,,both,985.07,689.55,,,,,,,,,,,,,,,,,,,Other,212.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,212.39,212.39, "BILAT RF ABLATION LUMBAR OR SACRAL,BILATERAL PROCEDURE",64635,HCPCS,360,RC,50,,,both,9707.88,6795.52,,,,,,,,,,,,,,,,,,,Other,2093.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,647.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,647.09,2093.02, ADD'L LEVEL RF ABLATION LUMBAR SACRAL,64636,HCPCS,360,RC,,,,both,3235.95,2265.17,,,,,,,,,,,,,,,,,,,Other,697.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,230.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,230.59,697.67, BILAT ADD'L LEVEL RF ABLATION LUMBAR OR,64636,HCPCS,360,RC,,,,both,4712.55,3298.79,,,,,,,,,,,,,,,,,,,Other,1016.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,230.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,230.59,1016.02, BILAT ADD'L LEVEL RF ABLATION CERVICAL O,64634,HCPCS,360,RC,,,,both,4712.55,3298.79,,,,,,,,,,,,,,,,,,,Other,1016.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,244.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,244.71,1016.02, ADD'L LEVEL RF ABLATION CERV OR THORACIC,64634,HCPCS,360,RC,,,,both,3235.94,2265.16,,,,,,,,,,,,,,,,,,,Other,697.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,244.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,244.71,697.67, INGUINAL NERVE BLOCK,360,RC,,,,,,both,2194.13,1535.89,,,,,,,,,,,,,,,,,,,Other,473.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,473.06,473.06, "BILAT CERV OR THORACIC RF ABLAT,BILATERAL PROCEDURE",64633,HCPCS,360,RC,50,,,both,6473.01,4531.11,,,,,,,,,,,,,,,,,,,Other,1395.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,639.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,639.35,1395.58, REV/RMV IMP SP NPG/R DTCH CN,360,RC,,,,,,both,10795.53,7556.87,,,,,,,,,,,,,,,,,,,Other,2327.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2327.52,2327.52, NEUROMONITORING SERVICES ANS,272,RC,,,,,,both,2474.19,1731.93,,,,,,,,,,,,,,,,,,,Other,533.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,533.43,533.43, INSJ STABLJ DEV W/O DCMPRN,22869,HCPCS,360,RC,,,,both,73204.88,51243.42,,,,,,,,,,,,,,,,,,,Other,15782.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,387.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,387.09,15782.97, IMPLANT NEUROELECTRODES,360,RC,,,,,,both,22356.76,15649.73,,,,,,,,,,,,,,,,,,,Other,4820.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4820.12,4820.12, INC/REPL SPINE NSTIM PG/RCVR,360,RC,,,,,,both,105805.87,74064.11,,,,,,,,,,,,,,,,,,,Other,22811.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22811.74,22811.74, LAMINECT IMPL NS ELECTRODES; EPIDURAL PE,360,RC,,,,,,both,74422.33,52095.63,,,,,,,,,,,,,,,,,,,Other,16045.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16045.45,16045.45, GENICULAR RF ABLAT,64624,HCPCS,360,RC,,,,both,5077.66,3554.36,,,,,,,,,,,,,,,,,,,Other,1094.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,379.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,379.51,1094.75, LUMBAR OR SACRAL RF ABLAT,64635,HCPCS,360,RC,,,,both,6471.9,4530.33,,,,,,,,,,,,,,,,,,,Other,1395.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,431.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,431.4,1395.34, CERV OR THORACIC RF ABLAT,64633,HCPCS,360,RC,,,,both,6283.4,4398.38,,,,,,,,,,,,,,,,,,,Other,1354.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,426.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,426.23,1354.7, BLOCK- STELLATE GANGLION,64510,HCPCS,360,RC,,,,both,3034,2123.8,,,,,,,,,,,,,,,,,,,Other,654.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,143.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,143.5,654.13, LAMINECTOMY SINGLE LUMBAR,360,RC,,,,,,both,23445.68,16411.98,,,,,,,,,,,,,,,,,,,Other,5054.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5054.89,5054.89, NECK SPINE FUSE & REMOV BEL C2,360,RC,,,,,,both,44751.13,31325.79,,,,,,,,,,,,,,,,,,,Other,9648.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9648.34,9648.34, LUMBAR SPINE FUSION,360,RC,,,,,,both,44751.13,31325.79,,,,,,,,,,,,,,,,,,,Other,9648.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9648.34,9648.34, KYPHOPLASTY; PERQ VERTEBRAL AUGMENTATION,360,RC,,,,,,both,22788.6,15952.02,,,,,,,,,,,,,,,,,,,Other,4913.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4913.22,4913.22, LUMBAR SPINE FUSION,360,RC,,,,,,both,46224.09,32356.86,,,,,,,,,,,,,,,,,,,Other,9965.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9965.91,9965.91, SPINE FUSION EXTRA SEGMENT,360,RC,,,,,,both,8866.27,6206.39,,,,,,,,,,,,,,,,,,,Other,1911.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1911.57,1911.57, REMOVE SPINAL LAMINA ADD-ON,360,RC,,,,,,both,9088.16,6361.71,,,,,,,,,,,,,,,,,,,Other,1959.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1959.41,1959.41, INSJ BIOMECHANICAL DEVICE,360,RC,,,,,,both,6374.4,4462.08,,,,,,,,,,,,,,,,,,,Other,1374.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1374.32,1374.32, INSERT SPINE FIXATION DEVICE,360,RC,,,,,,both,11533,8073.1,,,,,,,,,,,,,,,,,,,Other,2486.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2486.51,2486.51, ADDL LEVEL NECK SPINE FUSION,360,RC,,,,,,both,6062.45,4243.72,,,,,,,,,,,,,,,,,,,Other,1307.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1307.07,1307.07, SP BONE ALGRFT MORSEL ADD ON,20930,HCPCS,360,RC,,,,both,6602.82,4621.97,,,,,,,,,,,,,,,,,,,Other,1423.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1423.57,1423.57, SP BONE ALGRFT STRUCT ADD ON,20931,HCPCS,360,RC,,,,both,9309.73,6516.81,,,,,,,,,,,,,,,,,,,Other,2007.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,105.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,105.43,2007.18, SP BONE AGRFT LOCAL ADD ON,20936,HCPCS,360,RC,,,,both,3419.05,2393.34,,,,,,,,,,,,,,,,,,,Other,737.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,737.15,737.15, I&D ABSCESS P-SPINE l/s/ls,360,RC,,,,,,both,6966.86,4876.8,,,,,,,,,,,,,,,,,,,Other,1502.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1502.06,1502.06, PERQ VERTEBRAL AUGMENTATION,360,RC,,,,,,both,23480.63,16436.44,,,,,,,,,,,,,,,,,,,Other,5062.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5062.43,5062.43, PERQ VERTEBRAUL AUGMENTATION,360,RC,,,,,,both,23480.63,16436.44,,,,,,,,,,,,,,,,,,,Other,5062.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5062.43,5062.43, ADDL NECK SPINE FUSION,360,RC,,,,,,both,6058.04,4240.63,,,,,,,,,,,,,,,,,,,Other,1306.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1306.11,1306.11, NECK SPINE FUSION,360,RC,,,,,,both,44877.86,31414.5,,,,,,,,,,,,,,,,,,,Other,9675.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9675.67,9675.67, ADDL SPINAL FUSION,360,RC,,,,,,both,5274.14,3691.9,,,,,,,,,,,,,,,,,,,Other,1137.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1137.1,1137.1, NECK SPINE FUSION,360,RC,,,,,,both,13923.23,9746.26,,,,,,,,,,,,,,,,,,,Other,3001.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3001.85,3001.85, THORAX SPINE FUSION,360,RC,,,,,,both,6721.82,4705.27,,,,,,,,,,,,,,,,,,,Other,1449.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1449.22,1449.22, SPINE FUSION EXTRA SEGMENT,360,RC,,,,,,both,3737,2615.9,,,,,,,,,,,,,,,,,,,Other,805.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,805.7,805.7, LUMBAR SPINE FUSION COMBINED,360,RC,,,,,,both,46224.18,32356.93,,,,,,,,,,,,,,,,,,,Other,9965.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9965.93,9965.93, INSERT SPINE FIXATION DEVICE,360,RC,,,,,,both,2762.72,1933.9,,,,,,,,,,,,,,,,,,,Other,595.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,595.64,595.64, INSERT SPINE FIXATION DEVICE,360,RC,,,,,,both,6202.45,4341.72,,,,,,,,,,,,,,,,,,,Other,1337.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1337.25,1337.25, INSERT SPINE FIXATION DEVICE,360,RC,,,,,,both,9194.66,6436.26,,,,,,,,,,,,,,,,,,,Other,1982.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1982.37,1982.37, INSJ BIOMECHANICAL DEVICE,360,RC,,,,,,both,6265.81,4386.07,,,,,,,,,,,,,,,,,,,Other,1350.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1350.91,1350.91, CERV ARTIFIC DISKECTOMY,360,RC,,,,,,both,58847.56,41193.29,,,,,,,,,,,,,,,,,,,Other,12687.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12687.53,12687.53, LOW BACK DISK SURGERY,360,RC,,,,,,both,23480.64,16436.45,,,,,,,,,,,,,,,,,,,Other,5062.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5062.43,5062.43, SPINAL DISK SURGERY ADD ON,360,RC,,,,,,both,11989.89,8392.92,,,,,,,,,,,,,,,,,,,Other,2585.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2585.02,2585.02, REMOVE SPINE LAMINA 1 CRVL,360,RC,,,,,,both,23480.64,16436.45,,,,,,,,,,,,,,,,,,,Other,5062.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5062.43,5062.43, REMOVE SPINE LAMINA 1 THRC,360,RC,,,,,,both,23480.64,16436.45,,,,,,,,,,,,,,,,,,,Other,5062.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5062.43,5062.43, REMOVE SPINE LAMINA 1 LMBR,360,RC,,,,,,both,23480.64,16436.45,,,,,,,,,,,,,,,,,,,Other,5062.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5062.43,5062.43, REMOVE VERT BODY DCMPRN CRVL,360,RC,,,,,,both,7148.27,5003.79,,,,,,,,,,,,,,,,,,,Other,1541.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1541.17,1541.17, REMOVE VERTEBRAL BODY ADD-ON,360,RC,,,,,,both,7148.27,5003.79,,,,,,,,,,,,,,,,,,,Other,1541.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1541.17,1541.17, EXCISE INTRSPINL LESION THRC,360,RC,,,,,,both,23480.64,16436.45,,,,,,,,,,,,,,,,,,,Other,5062.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5062.43,5062.43, EXCISE INTRSPINL LESION LMBR,360,RC,,,,,,both,23480.64,16436.45,,,,,,,,,,,,,,,,,,,Other,5062.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5062.43,5062.43, BX/EXC XDRL SPINE LESN THRC,360,RC,,,,,,both,42262.66,29583.86,,,,,,,,,,,,,,,,,,,Other,9111.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9111.83,9111.83, REPAIR LAMINECTOMY DEFECT,360,RC,,,,,,both,4916.04,3441.23,,,,,,,,,,,,,,,,,,,Other,1059.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1059.9,1059.9, REMOVE SPINE ELTRD PLATE,360,RC,,,,,,both,8031.65,5622.16,,,,,,,,,,,,,,,,,,,Other,1731.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1731.62,1731.62, INSRT/REDO SPINE N GENERATOR,360,RC,,,,,,both,107133.49,74993.44,,,,,,,,,,,,,,,,,,,Other,23097.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23097.98,23097.98, REVISE/REMOVE NEURORECEIVER,360,RC,,,,,,both,12280.64,8596.45,,,,,,,,,,,,,,,,,,,Other,2647.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2647.71,2647.71, I&D DEEP ABSCESS PST SPINE LUMBAR SAC/LU,360,RC,,,,,,both,9341.69,6539.18,,,,,,,,,,,,,,,,,,,Other,2014.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2014.07,2014.07, DECOMPRESS SPINAL CORD LMBR,360,RC,,,,,,both,23500.46,16450.32,,,,,,,,,,,,,,,,,,,Other,5066.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5066.7,5066.7, NEURO CARPAL TUNNEL,360,RC,,,,,,both,6565.16,4595.61,,,,,,,,,,,,,,,,,,,Other,1415.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1415.45,1415.45, LAM FACETEC/FORAMOT DURING TLIF 1 VRT SG,360,RC,,,,,,both,5586.62,3910.63,,,,,,,,,,,,,,,,,,,Other,1204.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1204.48,1204.48, EXPLORATION OF SPINAL FUSION,360,RC,,,,,,both,13127.07,9188.95,,,,,,,,,,,,,,,,,,,Other,2830.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2830.2,2830.2, LAM FACETEC/FORAMOT DURING TLIF EA ADDL,360,RC,,,,,,both,5586.62,3910.63,,,,,,,,,,,,,,,,,,,Other,1204.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1204.48,1204.48, NEUROPLASTY; ULNAR NERVE TRANSPOSITION-,360,RC,,,,,,both,6565.18,4595.63,,,,,,,,,,,,,,,,,,,Other,1415.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1415.45,1415.45, DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUO,360,RC,,,,,,both,2313.33,1619.33,,,,,,,,,,,,,,,,,,,Other,498.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,498.75,498.75, ESTABLISH BRAIN CAVITY SHUNT,360,RC,,,,,,both,18959.76,13271.83,,,,,,,,,,,,,,,,,,,Other,4087.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4087.73,4087.73, THERAPEUTIC SPINAL PUNCTURE DRAINAGE CSF,62272,HCPCS,360,RC,,,,both,2313.33,1619.33,,,,,,,,,,,,,,,,,,,Other,498.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,208.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,208.34,498.75, TAP BLOCK SPINE,64486,HCPCS,360,RC,,,,both,794.03,555.82,,,,,,,,,,,,,,,,,,,Other,171.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,117.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,117.62,171.2, NEUROPLASTY; ULNAR NERVE TRANSPOSITION-N,360,RC,,,,,,both,6380.15,4466.11,,,,,,,,,,,,,,,,,,,Other,1375.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1375.56,1375.56, TOT DISC ARTHRP 2ND LVL CRV,360,RC,,,,,,both,18886.64,13220.65,,,,,,,,,,,,,,,,,,,Other,4071.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4071.96,4071.96, BX BONE TROCAR/NEEDLE DEEP VERT BODY,360,RC,,,,,,both,5395.4,3776.78,,,,,,,,,,,,,,,,,,,Other,1163.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1163.25,1163.25, CYSTO W/ LITHOTRIPSY BILAT,52353,HCPCS,360,RC,,,,both,24826.01,17378.21,,,,,,,,,,,,,,,,,,,Other,5352.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,348.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,348.13,5352.49, HOLMIUM 272 EXCALIBUR FIBER,272,RC,,,,,,both,1288.71,902.1,,,,,,,,,,,,,,,,,,,Other,277.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,277.85,277.85, TRANSRECTAL ULTRASOUND,76872,HCPCS,360,RC,,,,both,381.37,266.96,,,,,,,,,,,,,,,,,,,Other,82.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,110.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,82.22,110.29, PROSTATE BIOPSY,360,RC,,,,,,both,6428.88,4500.22,,,,,,,,,,,,,,,,,,,Other,1386.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1386.06,1386.06, URO ULTRASOUND RENTAL - 1 PT,360,RC,,,,,,both,2172.67,1520.87,,,,,,,,,,,,,,,,,,,Other,468.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,468.43,468.43, TRANSRECTAL PROBE RENTAL - 1 PT,272,RC,,,,,,both,1086.34,760.44,,,,,,,,,,,,,,,,,,,Other,234.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,234.21,234.21, URO ULTRASOUND RENTAL- 2 PT,360,RC,,,,,,both,1054.69,738.28,,,,,,,,,,,,,,,,,,,Other,227.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,227.39,227.39, URO ULTRASOUND RENTAL- 3 PT,360,RC,,,,,,both,703.13,492.19,,,,,,,,,,,,,,,,,,,Other,151.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,151.6,151.6, URO ULTRASOUND RENTAL- 4 PTS,360,RC,,,,,,both,527.35,369.15,,,,,,,,,,,,,,,,,,,Other,113.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,113.7,113.7, TRANSRECTAL PROBE RENTAL- 2 PT,360,RC,,,,,,both,527.35,369.15,,,,,,,,,,,,,,,,,,,Other,113.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,113.7,113.7, TRANSRECTAL PROBE RENTAL- 3 PTS,360,RC,,,,,,both,351.56,246.09,,,,,,,,,,,,,,,,,,,Other,75.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,75.79,75.79, TRANSRECTAL PROBE RENTAL- 4 PTS,360,RC,,,,,,both,263.67,184.57,,,,,,,,,,,,,,,,,,,Other,56.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,56.85,56.85, HOLMIUM MSTRPULSE HF,272,RC,,,,,,both,3709.62,2596.73,,,,,,,,,,,,,,,,,,,Other,799.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,799.8,799.8, HOLMIUM MP 200 FIBER,272,RC,,,,,,both,1128.87,790.21,,,,,,,,,,,,,,,,,,,Other,243.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,243.38,243.38, HOLMIUM LOW WATT,272,RC,,,,,,both,1764.9,1235.43,,,,,,,,,,,,,,,,,,,Other,380.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,380.51,380.51, HOLMIUM 200 FORTEC FIBER,360,RC,,,,,,both,798.05,558.64,,,,,,,,,,,,,,,,,,,Other,172.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,172.06,172.06, HOLMIUM HIGH WATT LASER,360,RC,,,,,,both,1933.6,1353.52,,,,,,,,,,,,,,,,,,,Other,416.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,416.88,416.88, FIBER DUST THULIUM FIBER LASER,272,RC,,,,,,both,1023.98,716.79,,,,,,,,,,,,,,,,,,,Other,220.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,220.77,220.77, THULIUM TFL 272 FORTEC FIBER,272,RC,,,,,,both,1095.57,766.9,,,,,,,,,,,,,,,,,,,Other,236.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,236.21,236.21, FIBER DUST THULIUM FIBER LASER 2,360,RC,,,,,,both,2724.62,1907.23,,,,,,,,,,,,,,,,,,,Other,587.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,587.43,587.43, CYSTOSCOPY W/ STENT PLACEMENT UNILAT,360,RC,,,,,,both,11039.27,7727.49,,,,,,,,,,,,,,,,,,,Other,2380.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2380.07,2380.07, CYSTOSCOPY W/ STENT PLACEMENT BILAT,52353,HCPCS,360,RC,,,,both,16558.91,11591.24,,,,,,,,,,,,,,,,,,,Other,3570.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,348.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,348.13,3570.1, CYSTO/URETERO W/LITHOTRIPSY,360,RC,,,,,,both,16531.21,11571.85,,,,,,,,,,,,,,,,,,,Other,3564.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3564.13,3564.13, TRANSURETHRAL RESECTION OF PROSTATE (TUR,360,RC,,,,,,both,16531.21,11571.85,,,,,,,,,,,,,,,,,,,Other,3564.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3564.13,3564.13, CYSTO W/URETEROSCOPY W/RMVL STONES,360,RC,,,,,,both,11268.17,7887.72,,,,,,,,,,,,,,,,,,,Other,2429.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2429.42,2429.42, CYSTO/URETERO W/LITHOTRIPSY &INDWELL STE,360,RC,,,,,,both,16531.21,11571.85,,,,,,,,,,,,,,,,,,,Other,3564.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3564.13,3564.13, CYSTOURETHROSCOPY W/DEST &/RMVL BLADDER,360,RC,,,,,,both,11268.17,7887.72,,,,,,,,,,,,,,,,,,,Other,2429.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2429.42,2429.42, URONAV MRI FUSION SYSTEM- RNTL,360,RC,,,,,,both,5707.62,3995.33,,,,,,,,,,,,,,,,,,,Other,1230.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1230.57,1230.57, US URONAV,360,RC,,,,,,both,1941.39,1358.97,,,,,,,,,,,,,,,,,,,Other,418.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,418.57,418.57, US BX SNGL NDL GUIDE UA 1322-S,360,RC,,,,,,both,179.29,125.5,,,,,,,,,,,,,,,,,,,Other,38.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,38.65,38.65, US LATEX FREE PROBE CVR 8818,360,RC,,,,,,both,43.29,30.3,,,,,,,,,,,,,,,,,,,Other,9.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.33,9.33, URONAV BK 8808e/8818 PROBE HLDR,360,RC,,,,,,both,273.06,191.14,,,,,,,,,,,,,,,,,,,Other,58.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,58.87,58.87, CYSTO W/ TX or BX,360,RC,,,,,,both,10939.87,7657.91,,,,,,,,,,,,,,,,,,,Other,2358.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2358.63,2358.63, URONAV MRI FUSION SYSTEM- RNTL T1,360,RC,,,,,,both,4365.63,3055.94,,,,,,,,,,,,,,,,,,,Other,941.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,941.23,941.23, US URONAV T1,360,RC,,,,,,both,938.64,657.05,,,,,,,,,,,,,,,,,,,Other,202.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,202.37,202.37, RADICAL NEPHRECTOMY,360,RC,,,,,,both,34318.03,24022.62,,,,,,,,,,,,,,,,,,,Other,7398.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7398.97,7398.97, TRANSURETHRAL INCISION PROSTATE,360,RC,,,,,,both,11337.38,7936.17,,,,,,,,,,,,,,,,,,,Other,2444.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2444.34,2444.34, URO ULTRASOUND RENTAL- 3 LASER ENUCLEATI,360,RC,,,,,,both,2324.42,1627.09,,,,,,,,,,,,,,,,,,,Other,501.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,501.14,501.14, MORCELLATOR RESECTOSCOPE,360,RC,,,,,,both,832.83,582.98,,,,,,,,,,,,,,,,,,,Other,179.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,179.56,179.56, PIRANHA BLADES RWOLF,360,RC,,,,,,both,1996.75,1397.73,,,,,,,,,,,,,,,,,,,Other,430.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,430.5,430.5, PIRAHNA TUBING SET,360,RC,,,,,,both,143.39,100.37,,,,,,,,,,,,,,,,,,,Other,30.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,30.92,30.92, PIRANHA OVERFLOW PROTECT,360,RC,,,,,,both,122.88,86.02,,,,,,,,,,,,,,,,,,,Other,26.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.49,26.49, PIRANHA TISSUE CONTAINER,360,RC,,,,,,both,167.25,117.08,,,,,,,,,,,,,,,,,,,Other,36.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.06,36.06, HOLMIUM MP 550 FORTEC FIBER,360,RC,,,,,,both,1266.32,886.42,,,,,,,,,,,,,,,,,,,Other,273.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,273.02,273.02, ON CALL HOLMIUM PROFLEX 273 FIBER,360,RC,,,,,,both,865.77,606.04,,,,,,,,,,,,,,,,,,,Other,186.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,186.66,186.66, TRURL RESCJ POSTOP BLADDER NECK CONTRAC,360,RC,,,,,,both,11485.07,8039.55,,,,,,,,,,,,,,,,,,,Other,2476.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2476.19,2476.19, CYSTOURETHROSCOPY W/RMVL STONE,360,RC,,,,,,both,11485.07,8039.55,,,,,,,,,,,,,,,,,,,Other,2476.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2476.19,2476.19, HOLMIUM MP 1000 FORTEC FIBER,360,RC,,,,,,both,1491.84,1044.29,,,,,,,,,,,,,,,,,,,Other,321.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,321.64,321.64, TRANSPERINEAL ACCESS SYSTEM,360,RC,,,,,,both,882.45,617.72,,,,,,,,,,,,,,,,,,,Other,190.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,190.26,190.26, TIF EGD PARTIAL/COMPL ESOPHAGOGASTRIC FU,43210,HCPCS,360,RC,,,,both,33966.23,23776.36,,,,,,,,,,,,,,,,,,,Other,7323.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,384.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,384.42,7323.12, K PUMP,270,RC,,,,,,both,35.88,25.12,,,,,,,,,,,,,,,,,,,Other,7.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.73,7.73, HOME SLEEP TEST,95806,HCPCS,920,RC,,,,both,1097.39,768.17,,,,,,,,,,,,,,,,,,,Other,236.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,96.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,96.22,236.6, SPLIT NIGHT POLYSOMNOGRAPHY WO PAP,95810,HCPCS,920,RC,,,,both,7166.86,5016.8,,,,,,,,,,,,,,,,,,,Other,1545.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,615.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,615.26,1545.18, TITRATION POLYSOMNOGRAPHY W/PAP,95811,HCPCS,920,RC,,,,both,7166.86,5016.8,,,,,,,,,,,,,,,,,,,Other,1545.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,646.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,646.46,1545.18, INTUBATION HOSPITAL,31500,HCPCS,450,RC,,,,both,1085.8,760.06,,,,,,,,,,,,,,,,,,,Other,234.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,137.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,137.5,234.1, SPIROMETRY P & P,94060,HCPCS,460,RC,,,,both,904.67,633.27,,,,,,,,,,,,,,,,,,,Other,195.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,39.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,39.88,195.05, VENT INIT DAY MANAGEMENT,94002,HCPCS,410,RC,,,,both,2130,1491,,,,,,,,,,,,,,,,,,,Other,459.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,86.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,86.3,459.23, STRESS TEST WITH EKG,93017,HCPCS,482,RC,,,,both,1615.97,1131.18,,,,,,,,,,,,,,,,,,,Other,348.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,35.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,35.39,348.4, EKG RHYTHM STRIP,93041,HCPCS,730,RC,,,,both,216,151.2,,,,,,,,,,,,,,,,,,,Other,46.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.39,46.57, EKG 12 LEAD,93005,HCPCS,730,RC,,,,both,346.5,242.55,,,,,,,,,,,,,,,,,,,Other,74.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.49,74.71, DOBUTAMINE STRESS TEST EKG ONLY,93017,HCPCS,482,RC,,,,both,1615.97,1131.18,,,,,,,,,,,,,,,,,,,Other,348.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,35.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,35.39,348.4, CONT NEB (INT.HR),94644,HCPCS,410,RC,,,,both,693.94,485.76,,,,,,,,,,,,,,,,,,,Other,149.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,56.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,56.31,149.62, CONT NEB (SUB HR),94645,HCPCS,410,RC,,,,both,700.88,490.62,,,,,,,,,,,,,,,,,,,Other,151.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.15,151.11, DEMO/EVAL TX OP,94664,HCPCS,410,RC,,,,both,687.67,481.37,,,,,,,,,,,,,,,,,,,Other,148.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.36,148.26, END TIDAL CO2 MONITORING,94770,HCPCS,460,RC,,,,both,918.12,642.68,,,,,,,,,,,,,,,,,,,Other,197.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.35,197.95, OXYGEN PER HOUR,271,RC,,,,,,both,14.98,10.49,,,,,,,,,,,,,,,,,,,Other,3.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.23,3.23, HOLTER HOOKUP 48 HOUR RECORD ONLY,93225,HCPCS,731,RC,,,,both,749.7,524.79,,,,,,,,,,,,,,,,,,,Other,161.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.35,161.63, HOLTER HOOKUP 3 - 7 DAY RECORD ONLY,93242,HCPCS,731,RC,,,,both,480,336,,,,,,,,,,,,,,,,,,,Other,103.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.67,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.67,103.49, HOLTER HOOKUP 14 DAY RECORD ONLY,93246,HCPCS,731,RC,,,,both,528.66,370.06,,,,,,,,,,,,,,,,,,,Other,113.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.67,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.67,113.98, NEB/MDI INITIAL,94640,HCPCS,410,RC,,,,both,700.88,490.62,,,,,,,,,,,,,,,,,,,Other,151.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.99,151.11, SPUTUM INDUCT 0.9% SALINE,89220,HCPCS,300,RC,,,,both,523.82,366.67,,,,,,,,,,,,,,,,,,,Other,19.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.04,19.04, PULSE OX,94760,HCPCS,460,RC,,,,both,52.24,36.57,,,,,,,,,,,,,,,,,,,Other,11.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.8,11.26, DEMONSTRATION & EVALUATION OF TX,94664,HCPCS,410,RC,,,,both,694.55,486.19,,,,,,,,,,,,,,,,,,,Other,149.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.36,149.74, CPT INITIAL,94667,HCPCS,410,RC,,,,both,395,276.5,,,,,,,,,,,,,,,,,,,Other,85.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.93,85.16, SPIROMTRY PRE ONLY,94010,HCPCS,460,RC,,,,both,508.03,355.62,,,,,,,,,,,,,,,,,,,Other,109.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.51,109.53, NEB/MDI SUB,94640,HCPCS,410,RC,,,,both,700.88,490.62,,,,,,,,,,,,,,,,,,,Other,151.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.99,151.11, CPT SUBSEQUENT,94668,HCPCS,410,RC,,,,both,395,276.5,,,,,,,,,,,,,,,,,,,Other,85.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,35.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,35.39,85.16, LUNG DIFFUSION,94729,HCPCS,460,RC,,,,both,518,362.6,,,,,,,,,,,,,,,,,,,Other,111.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,57.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,57.75,111.68, BIPAP CPAP MANAGEMENT,94660,HCPCS,410,RC,,,,both,930.54,651.38,,,,,,,,,,,,,,,,,,,Other,200.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,65.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.25,200.63, ARTERIAL PUNCTURE,36600,HCPCS,300,RC,,,,both,388.27,271.79,,,,,,,,,,,,,,,,,,,Other,25.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,25.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,25.81,25.81, FUNCTIONAL RESIDUAL CAPACITY,94727,HCPCS,460,RC,,,,both,508.03,355.62,,,,,,,,,,,,,,,,,,,Other,109.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,45.67,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,45.67,109.53, PULMONARY COMPLNC STDY,94750,HCPCS,460,RC,,,,both,503,352.1,,,,,,,,,,,,,,,,,,,Other,108.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,81.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,81.22,108.45, "Vital Capacity, Total",94150,HCPCS,460,RC,,,,both,493.71,345.6,,,,,,,,,,,,,,,,,,,Other,106.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,106.45,106.45, FV LOOP ONLY,94375,HCPCS,460,RC,,,,both,1119,783.3,,,,,,,,,,,,,,,,,,,Other,241.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,38.94,241.26, PULSE OX MULTIPLE DETERMINATIONS,94761,HCPCS,460,RC,,,,both,277,193.9,,,,,,,,,,,,,,,,,,,Other,59.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.1,59.72, NIPPV INIT,94002,HCPCS,410,RC,,,,both,2130,1491,,,,,,,,,,,,,,,,,,,Other,459.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,86.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,86.3,459.23, NIPPV SUBS,94003,HCPCS,410,RC,,,,both,1716.86,1201.8,,,,,,,,,,,,,,,,,,,Other,370.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,59.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,59.35,370.16, NASOTRACHEAL SX,31720,HCPCS,410,RC,,,,both,694.55,486.19,,,,,,,,,,,,,,,,,,,Other,149.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,45.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,45.49,149.74, INTUBATION/ASSIST (ED),31500,HCPCS,450,RC,,,,both,1085.8,760.06,,,,,,,,,,,,,,,,,,,Other,234.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,137.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,137.5,234.1, INTUBATION/ASSIST EMERG,31500,HCPCS,450,RC,,,,both,1085.8,760.06,,,,,,,,,,,,,,,,,,,Other,234.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,137.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,137.5,234.1, IGV PLETHYSMOGRAPHY,94726,HCPCS,460,RC,,,,both,927.3,649.11,,,,,,,,,,,,,,,,,,,Other,199.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,58.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,58.43,199.93, OXYGEN PER DAY,270,RC,,,,,,both,230.37,161.26,,,,,,,,,,,,,,,,,,,Other,49.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,49.67,49.67, VENT SUBS DAY MANAGEMENT,94003,HCPCS,410,RC,,,,both,1716.86,1201.8,,,,,,,,,,,,,,,,,,,Other,370.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,59.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,59.35,370.16, PULSE OX OVERNIGHT STUDY,94762,HCPCS,460,RC,,,,both,508.03,355.62,,,,,,,,,,,,,,,,,,,Other,109.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,21.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,21.73,109.53, EKG 12 LEAD SUBSEQUENT,93005,HCPCS,730,RC,,,,both,346.5,242.55,,,,,,,,,,,,,,,,,,,Other,74.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.49,74.71, "PULSE OX 6 MINUTE WALK TEST includes HR,",94618,HCPCS,460,RC,,,,both,425,297.5,,,,,,,,,,,,,,,,,,,Other,91.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,35.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,35.15,91.63, SMOKING CESSATION,99406,HCPCS,942,RC,,,,both,113.36,79.35,,,,,,,,,,,,,,,,,,,Other,24.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.86,24.44, Treadmill ECHO Stress Test,93017,HCPCS,480,RC,,,,both,1615.97,1131.18,,,,,,,,,,,,,,,,,,,Other,348.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,35.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,35.39,348.4, "OT EVAL LOW COMPLEX 20 MIN,OUTPATIENT OT",97165,HCPCS,434,RC,GO,,,both,382.03,267.42,,,,,,,,,,,,,,,,,,,Other,82.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,94.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,82.37,94.55, "OT EVAL MOD COMPLEX 30 MIN,OUTPATIENT OT",97166,HCPCS,434,RC,GO,,,both,443.39,310.37,,,,,,,,,,,,,,,,,,,Other,95.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,94.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,94.55,95.6, "OT EVAL HIGH COMPLEX 45 MINS,OUTPATIENT OT",97167,HCPCS,434,RC,GO,,,both,507.02,354.91,,,,,,,,,,,,,,,,,,,Other,109.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,94.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,94.55,109.31, "ST EVALUATION FLUENCY,OUTPATIENT ST",92521,HCPCS,444,RC,GN,,,both,622.83,435.98,,,,,,,,,,,,,,,,,,,Other,134.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,125.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,125.83,134.28, "ST EVALUATION SOUND PRODUCTION,OUTPATIENT ST",92522,HCPCS,444,RC,GN,,,both,622.83,435.98,,,,,,,,,,,,,,,,,,,Other,134.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,106.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,106.44,134.28, "ST EVALUATION SOUND PROD/COMPREHENSION,OUTPATIENT ST",92523,HCPCS,444,RC,GN,,,both,622.83,435.98,,,,,,,,,,,,,,,,,,,Other,134.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,213.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,134.28,213.77, "ST ANALYSIS VOICE RESONANCE,OUTPATIENT ST",92524,HCPCS,444,RC,GN,,,both,622.83,435.98,,,,,,,,,,,,,,,,,,,Other,134.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,104.12,134.28, "PT EVAL LOW COMPLEX 20 MIN,OUTPATIENT PT",97161,HCPCS,424,RC,GP,,,both,434.04,303.83,,,,,,,,,,,,,,,,,,,Other,93.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,92.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,92.16,93.58, "PT EVAL MOD COMPLEX 30 MIN,OUTPATIENT PT",97162,HCPCS,424,RC,GP,,,both,463.04,324.13,,,,,,,,,,,,,,,,,,,Other,99.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,92.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,92.16,99.83, "PT EVAL HIGH COMPLEX 45 MIN,OUTPATIENT PT",97163,HCPCS,424,RC,GP,,,both,541.2,378.84,,,,,,,,,,,,,,,,,,,Other,116.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,92.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,92.16,116.68, "OT RE-EVAL EST PLAN CARE,OUTPATIENT OT",97168,HCPCS,434,RC,GO,,,both,237.61,166.33,,,,,,,,,,,,,,,,,,,Other,51.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,64.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,51.22,64.21, "OT THERAPEUTIC EXERCISE,15 MINUTES,OUTPATIENT OT",97110,HCPCS,430,RC,GO,,,both,170.72,119.5,,,,,,,,,,,,,,,,,,,Other,36.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.5,36.81, "OT THERAPEUTIC ACTIVITIES, 15 MINUTES,OUTPATIENT OT",97530,HCPCS,430,RC,GO,,,both,150.11,105.08,,,,,,,,,,,,,,,,,,,Other,32.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,32.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,32.36,32.85, "OT NEUROMUSC RE-EDUCATION 15 MIN.,OUTPATIENT OT",97112,HCPCS,430,RC,GO,,,both,170.72,119.5,,,,,,,,,,,,,,,,,,,Other,36.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.93,36.81, "OT PROSTHETIC TRAINING, 15 MIN.,OUTPATIENT OT",97761,HCPCS,430,RC,GO,,,both,82.88,58.02,,,,,,,,,,,,,,,,,,,Other,17.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,37.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.87,37.8, "OT SELF CARE/HOME MGMT TRN 15 MIN.,OUTPATIENT OT",97535,HCPCS,430,RC,GO,,,both,149.92,104.94,,,,,,,,,,,,,,,,,,,Other,32.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.48,32.32, "PT TENS, ELEC STIM MANUAL, 15 MINUTES,OUTPATIENT PT",97032,HCPCS,420,RC,GP,,,both,259.07,181.35,,,,,,,,,,,,,,,,,,,Other,55.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.07,55.86, SELECT DEBRIDEMENT GREATER THAN 20 CM,97598,HCPCS,420,RC,,,,both,645.1,451.57,,,,,,,,,,,,,,,,,,,Other,139.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,45.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,45.4,139.08, SELECT DEBRIDEMENT 20 CM OR LESS,97597,HCPCS,420,RC,,,,both,718.42,502.89,,,,,,,,,,,,,,,,,,,Other,154.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,94.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,94.05,154.89, PT STRAPPING-SHOULDER,29240,HCPCS,420,RC,,,,both,214.61,150.23,,,,,,,,,,,,,,,,,,,Other,46.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27,46.27, PT TAPING- KNEE,29530,HCPCS,420,RC,,,,both,209.38,146.57,,,,,,,,,,,,,,,,,,,Other,45.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27,45.14, "PT THERAPEUTIC EXERCISE, 15 MINS.,OUTPATIENT PT",97110,HCPCS,420,RC,GP,,,both,226.53,158.57,,,,,,,,,,,,,,,,,,,Other,48.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.5,48.84, "PT AQUATIC THERAPY, 15 MINS,OUTPATIENT PT",97113,HCPCS,420,RC,GP,,,both,222.94,156.06,,,,,,,,,,,,,,,,,,,Other,48.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.75,48.07, "PT NEUROMUSC, 15 MINS.,OUTPATIENT PT",97112,HCPCS,420,RC,GP,,,both,230.63,161.44,,,,,,,,,,,,,,,,,,,Other,49.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.93,49.73, "PT GAIT TRAINING, 15 MINUTES,OUTPATIENT PT",97116,HCPCS,420,RC,GP,,,both,185.81,130.07,,,,,,,,,,,,,,,,,,,Other,40.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.5,40.06, "PT WHIRLPOOL,OUTPATIENT PT",97022,HCPCS,420,RC,GP,,,both,235.75,165.03,,,,,,,,,,,,,,,,,,,Other,50.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.74,50.83, "PT RE EVALUATION,OUTPATIENT PT",97164,HCPCS,424,RC,GP,,,both,231.95,162.37,,,,,,,,,,,,,,,,,,,Other,50.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,50.01,63.32, "PT MECHANICAL TRACTION,OUTPATIENT PT",97012,HCPCS,420,RC,GP,,,both,232.68,162.88,,,,,,,,,,,,,,,,,,,Other,50.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.75,50.17, "PT CHECKOUT ORTH/PROST USE, 15MIN,OUTPATIENT PT",97763,HCPCS,420,RC,GP,,,both,169.64,118.75,,,,,,,,,,,,,,,,,,,Other,36.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,46.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.57,46.4, "PT SELF CARE/HOME MGMT TRN 15 MIN,OUTPATIENT PT",97535,HCPCS,420,RC,GP,,,both,149.92,104.94,,,,,,,,,,,,,,,,,,,Other,32.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.48,32.32, "PT ULTRASOUND, 15 MINUTES,OUTPATIENT PT",97035,HCPCS,420,RC,GP,,,both,231.21,161.85,,,,,,,,,,,,,,,,,,,Other,49.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.66,49.85, "PT THERAPEUTIC ACTIVITY, 15 MINUTES,OUTPATIENT PT",97530,HCPCS,420,RC,GP,,,both,241.9,169.33,,,,,,,,,,,,,,,,,,,Other,52.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,32.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,32.85,52.16, "PT IONTOPHORESIS, 15 MINUTES,OUTPATIENT PT",97033,HCPCS,420,RC,GP,,,both,247.49,173.24,,,,,,,,,,,,,,,,,,,Other,53.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.98,53.36, "ELECTRICAL STIMULATION (UNATTENDED),OUTPATIENT PT",G0283,HCPCS,429,RC,GP,,,both,205,143.5,,,,,,,,,,,,,,,,,,,Other,44.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.08,44.2, STANDARDIZED COGNITIVE ASSESSMENT,96125,HCPCS,918,RC,,,,both,420.53,294.37,,,,,,,,,,,,,,,,,,,Other,90.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,97.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,90.67,97.74, "PHYSICAL PERFORMANCE TESTING, 15 MINUTES,OUTPATIENT PT",97750,HCPCS,420,RC,GP,,,both,75.9,53.13,,,,,,,,,,,,,,,,,,,Other,16.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,31.67,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.37,31.67, "CANALITH REPOSITIONING, UNTIMED,OUTPATIENT PT",95992,HCPCS,420,RC,GP,,,both,329.61,230.73,,,,,,,,,,,,,,,,,,,Other,71.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,38.96,71.06, "ST TREAT SPEECH LANG VOICE, INDIV I,OUTPATIENT ST",92507,HCPCS,440,RC,GN,,,both,389.73,272.81,,,,,,,,,,,,,,,,,,,Other,84.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,72.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.05,84.03, "ST TREAT SPEECH LANG VOICE, INDIV II,OUTPATIENT ST",92507,HCPCS,440,RC,GN,,,both,412.01,288.41,,,,,,,,,,,,,,,,,,,Other,88.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,72.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.05,88.83, "ST TREAT SPEECH LANG VOICE, INDIV III,OUTPATIENT ST",92507,HCPCS,440,RC,GN,,,both,445.41,311.79,,,,,,,,,,,,,,,,,,,Other,96.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,72.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.05,96.03, "ST TREAT SPEECH LANG VOICE, INDIV IV,OUTPATIENT ST",92507,HCPCS,440,RC,GN,,,both,412.01,288.41,,,,,,,,,,,,,,,,,,,Other,88.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,72.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.05,88.83, "ST VIDEO SWALLOWING EVAL,OUTPATIENT ST",92611,HCPCS,444,RC,GN,,,both,819.4,573.58,,,,,,,,,,,,,,,,,,,Other,176.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,86.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,86.68,176.66, "ST ASPHAGIA ASSESS W/REPORT PER HR,OUTPATIENT ST",96105,HCPCS,440,RC,GN,,,both,455.79,319.05,,,,,,,,,,,,,,,,,,,Other,98.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,93.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,93.01,98.26, "ST SWALLOW EVALUATION,OUTPATIENT ST",92610,HCPCS,444,RC,GN,,,both,839.9,587.93,,,,,,,,,,,,,,,,,,,Other,181.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,79.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,79.82,181.08, "ST TX OF SWALLOW/ORAL DYSFUNCTION,OUTPATIENT ST",92526,HCPCS,440,RC,GN,,,both,429.69,300.78,,,,,,,,,,,,,,,,,,,Other,92.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,79.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,79.34,92.64, "ST DYSPHAGIA TREATMENT,OUTPATIENT ST",92526,HCPCS,440,RC,GN,,,both,429.69,300.78,,,,,,,,,,,,,,,,,,,Other,92.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,79.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,79.34,92.64, "VASOPNEUMATIC DEVICE THERAPY,OUTPATIENT PT",97016,HCPCS,420,RC,GP,,,both,182.5,127.75,,,,,,,,,,,,,,,,,,,Other,39.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.49,39.35, PT MYOFACIAL RELEASE,97140,HCPCS,420,RC,,,,both,207.05,144.94,,,,,,,,,,,,,,,,,,,Other,44.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.24,44.64, "PT MANUAL THERAPY,15 MINUTES,OUTPATIENT PT",97140,HCPCS,420,RC,GP,,,both,207.05,144.94,,,,,,,,,,,,,,,,,,,Other,44.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.24,44.64, THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTE,97129,HCPCS,440,RC,,,,both,184.44,129.11,,,,,,,,,,,,,,,,,,,Other,39.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,21.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,21.66,39.77, THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MI,97130,HCPCS,440,RC,,,,both,177.61,124.33,,,,,,,,,,,,,,,,,,,Other,38.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.2,38.29, "BFB TRAING W/EMG &/MANOMETRY 1ST 15 MIN,OUTPATIENT PT",90912,HCPCS,420,RC,GP,,,both,262.14,183.5,,,,,,,,,,,,,,,,,,,Other,56.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,77.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,56.52,77.15, "BFB TRAING W/EMG&/MANOMETRY EA ADDL 15 M,OUTPATIENT PT",90913,HCPCS,420,RC,GP,,,both,106.52,74.56,,,,,,,,,,,,,,,,,,,Other,22.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,31.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,22.96,31.35, PULMONARY REHAB 1 HR SESSION FOR COPD DX,94625,HCPCS,948,RC,,,,both,200.57,140.4,,,,,,,,,,,,,,,,,,,Other,43.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,80.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,43.25,80.09, PULMONARY REHAB 15 MIN SESSION FOR NON C,G0238,HCPCS,948,RC,,,,both,120.92,84.64,,,,,,,,,,,,,,,,,,,Other,26.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.38,26.07, PULMONARY REHAB GROUP SESSION FOR NON CO,G0239,HCPCS,948,RC,,,,both,119.43,83.6,,,,,,,,,,,,,,,,,,,Other,25.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.06,25.74, PULMONARY REHAB COPD DX 1HR SESS WO CONT,94625,HCPCS,948,RC,,,,both,191.2,133.84,,,,,,,,,,,,,,,,,,,Other,41.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,80.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,41.22,80.09, PULMONARY REHABILITATION 1 HOUR SESSION,94626,HCPCS,948,RC,,,,both,196.94,137.86,,,,,,,,,,,,,,,,,,,Other,42.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,100.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,42.46,100.81, CARDIAC REHAB PHASE 2 W ECG MONITOR,93798,HCPCS,943,RC,,,,both,377.61,264.33,,,,,,,,,,,,,,,,,,,Other,81.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.53,81.41, MRA ABDOMEN WO CONTRAST,74185,HCPCS,610,RC,,,,both,2865.22,2005.65,,,,,,,,,,,,,,,,,,,Other,617.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,308.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,308.55,617.74, MMRI U EXTR; ANY JOINT W CONTRAST,73222,HCPCS,610,RC,,,,both,4033.71,2823.6,,,,,,,,,,,,,,,,,,,Other,869.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,286.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,286.56,869.67, MRA/MRV BRAIN WO CONTRAST,70544,HCPCS,615,RC,,,,both,3315.61,2320.93,,,,,,,,,,,,,,,,,,,Other,714.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,197.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,197.62,714.84, MRA/MRV BRAIN W WO CONTRAST,70546,HCPCS,615,RC,,,,both,3817.59,2672.31,,,,,,,,,,,,,,,,,,,Other,823.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,299.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,299.83,823.07, MRA/MRV NECK WO CONTRAST,70547,HCPCS,615,RC,,,,both,3315.61,2320.93,,,,,,,,,,,,,,,,,,,Other,714.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,197.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,197.62,714.84, MRI THORACIC SPINE W CONTRAST,72147,HCPCS,612,RC,,,,both,3936.49,2755.54,,,,,,,,,,,,,,,,,,,Other,848.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,250.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,250.17,848.71, MRI LUMBAR SPINE WITH CONTRAST,72149,HCPCS,612,RC,,,,both,4053.06,2837.14,,,,,,,,,,,,,,,,,,,Other,873.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,248.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,248.68,873.84, MRI CERVICAL SPINE WITH CONTRAST,72142,HCPCS,612,RC,,,,both,4053.06,2837.14,,,,,,,,,,,,,,,,,,,Other,873.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,252.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,252.99,873.84, MRI BRAIN WO CONTRAST,70551,HCPCS,611,RC,,,,both,3234.75,2264.33,,,,,,,,,,,,,,,,,,,Other,697.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,181.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,181.06,697.42, MRI BRAIN WITH AND WITHOUT CONTRAST,70553,HCPCS,611,RC,,,,both,4167.3,2917.11,,,,,,,,,,,,,,,,,,,Other,898.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,293.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,293.36,898.47, MRI ORBIT FACE NECK WO CONTRAST,70540,HCPCS,614,RC,,,,both,3583.26,2508.28,,,,,,,,,,,,,,,,,,,Other,772.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,206.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,206.51,772.55, MRI CERVICAL SPINE WO CONTRAST,72141,HCPCS,612,RC,,,,both,3514.12,2459.88,,,,,,,,,,,,,,,,,,,Other,757.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,176.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,176.87,757.65, MRI THORACIC SPINE WO CONTRAST,72146,HCPCS,612,RC,,,,both,3556.98,2489.89,,,,,,,,,,,,,,,,,,,Other,766.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,176.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,176.58,766.89, MRI LUMBAR SPINE WO CONTRAST,72148,HCPCS,612,RC,,,,both,3556.98,2489.89,,,,,,,,,,,,,,,,,,,Other,766.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,177.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,177.77,766.89, MRI CHEST WO CONTRAST,71550,HCPCS,614,RC,,,,both,2768.1,1937.67,,,,,,,,,,,,,,,,,,,Other,596.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,304.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,304.12,596.8, MRI ABDOMEN WO CONTRAST,74181,HCPCS,614,RC,,,,both,3821.63,2675.14,,,,,,,,,,,,,,,,,,,Other,823.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,179.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,179.29,823.94, MRI PELVIS WO CONTRAST,72195,HCPCS,614,RC,,,,both,3821.63,2675.14,,,,,,,,,,,,,,,,,,,Other,823.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,209.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,209.48,823.94, "MRI ELBOW JT RIGHT WO CONTRAST,RIGHT",73221,HCPCS,610,RC,RT,,,both,3718.27,2602.79,,,,,,,,,,,,,,,,,,,Other,801.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,189.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,189.17,801.66, "MRI ELBOW LEFT WO CONTRAST,LEFT",73221,HCPCS,610,RC,LT,,,both,3718.27,2602.79,,,,,,,,,,,,,,,,,,,Other,801.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,189.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,189.17,801.66, "MRI SHOULDER JT RIGHT WO CONTRAST,RIGHT",73221,HCPCS,610,RC,RT,,,both,3584.76,2509.33,,,,,,,,,,,,,,,,,,,Other,772.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,189.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,189.17,772.88, "MRI SHOULDER JT LEFT WO CONTRAST,LEFT",73221,HCPCS,610,RC,LT,,,both,3584.76,2509.33,,,,,,,,,,,,,,,,,,,Other,772.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,189.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,189.17,772.88, MRI GREAT VESSELS,71550,HCPCS,610,RC,,,,both,4253.55,2977.49,,,,,,,,,,,,,,,,,,,Other,917.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,304.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,304.12,917.06, "MRI UPPER EXTREMITY LEFT WO CONTRAST,LEFT",73218,HCPCS,614,RC,LT,,,both,3493.97,2445.78,,,,,,,,,,,,,,,,,,,Other,753.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,277.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,277.24,753.3, "MRI UPPER EXTREMITY RT WO CONTRAST,RIGHT",73218,HCPCS,610,RC,RT,,,both,3598.79,2519.15,,,,,,,,,,,,,,,,,,,Other,775.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,277.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,277.24,775.9, "MRI UPPER EXTREMITY RIGHT W CONTRAST,RIGHT",73219,HCPCS,610,RC,RT,,,both,4076.71,2853.7,,,,,,,,,,,,,,,,,,,Other,878.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,301.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,301.81,878.94, "MRI UPPER EXTREMITY LEFT W CONTRAST,LEFT",73219,HCPCS,614,RC,LT,,,both,4076.71,2853.7,,,,,,,,,,,,,,,,,,,Other,878.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,301.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,301.81,878.94, "MRI KNEE RIGHT WO CONTRAST,RIGHT",73721,HCPCS,614,RC,RT,,,both,3584.76,2509.33,,,,,,,,,,,,,,,,,,,Other,772.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,188.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,188.57,772.88, "MRI KNEE LEFT WO CONTRAST,LEFT",73721,HCPCS,614,RC,LT,,,both,3584.76,2509.33,,,,,,,,,,,,,,,,,,,Other,772.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,188.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,188.57,772.88, "MRI HIP JT LEFT WITHOUT CONTRAST,LEFT",73721,HCPCS,610,RC,LT,,,both,3584.76,2509.33,,,,,,,,,,,,,,,,,,,Other,772.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,188.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,188.57,772.88, "MRI HIP JT RIGHT WO CONTRAST,RIGHT",73721,HCPCS,610,RC,RT,,,both,3584.76,2509.33,,,,,,,,,,,,,,,,,,,Other,772.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,188.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,188.57,772.88, "MRI SHOULDER LT W/CONTRAST,LEFT",73222,HCPCS,610,RC,LT,,,both,4076.71,2853.7,,,,,,,,,,,,,,,,,,,Other,878.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,286.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,286.56,878.94, "MRI SHOULDER JT RIGHT W CONTRAST,RIGHT",73222,HCPCS,610,RC,RT,,,both,4077.62,2854.33,,,,,,,,,,,,,,,,,,,Other,879.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,286.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,286.56,879.14, "MRI LOWER EXT RIGHT WO CONTRAST,RIGHT",73718,HCPCS,614,RC,RT,,,both,3584.76,2509.33,,,,,,,,,,,,,,,,,,,Other,772.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,204.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,204.71,772.88, "MRI LOWER EXT RIGHT WITH CONTRAST,RIGHT",73719,HCPCS,614,RC,RT,,,both,4076.71,2853.7,,,,,,,,,,,,,,,,,,,Other,878.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,240.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,240.54,878.94, "MRI LOWER EXT RIGHT WOW CONTRAST,RIGHT",73720,HCPCS,614,RC,RT,,,both,4436.06,3105.24,,,,,,,,,,,,,,,,,,,Other,956.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,308.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,308.92,956.41, "MRI LOWER EXT LEFT WITHOUT CONTRAST,LEFT",73718,HCPCS,614,RC,LT,,,both,3584.76,2509.33,,,,,,,,,,,,,,,,,,,Other,772.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,204.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,204.71,772.88, "MRI LOWER EXT LEFT WITH CONTRAST,LEFT",73719,HCPCS,614,RC,LT,,,both,4076.71,2853.7,,,,,,,,,,,,,,,,,,,Other,878.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,240.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,240.54,878.94, "MRI LOWER EXT LEFT WOW CONTRAST,LEFT",73720,HCPCS,614,RC,LT,,,both,4435.16,3104.61,,,,,,,,,,,,,,,,,,,Other,956.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,308.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,308.92,956.23, MMRI BRAIN /+CONT,70553,HCPCS,611,RC,,,,both,2781.59,1947.11,,,,,,,,,,,,,,,,,,,Other,599.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,293.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,293.36,599.71, MMRI CONTRAST MEDIA,A9579,HCPCS,636,RC,,,,both,303.48,212.44,,,,,,,,,,,,,,,,,,,Other,65.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.43,65.43, MRI CONTRAST GADOLINIUM,A9579,HCPCS,636,RC,,,,both,12.84,8.99,,,,,,,,,,,,,,,,,,,Other,2.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.43,2.76, MRI BRAIN W CONTRAST GADOLINIUM,70552,HCPCS,611,RC,,,,both,3817.59,2672.31,,,,,,,,,,,,,,,,,,,Other,823.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,248.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,248.09,823.07, MRI ORBIT FACE NECK WITH CONTRAST,70542,HCPCS,614,RC,,,,both,3962.13,2773.49,,,,,,,,,,,,,,,,,,,Other,854.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,245.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,245.32,854.24, MRI ORBIT FACE NECK WO,70540,HCPCS,614,RC,,,,both,3583.26,2508.28,,,,,,,,,,,,,,,,,,,Other,772.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,206.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,206.51,772.55, MRI ORBIT FACE NECK WOW CONTRAST,70543,HCPCS,614,RC,,,,both,4311.84,3018.29,,,,,,,,,,,,,,,,,,,Other,929.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,310.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,310.71,929.63, MRI CERVICAL SPINE WOW CONTRAST,72156,HCPCS,612,RC,,,,both,4402.76,3081.93,,,,,,,,,,,,,,,,,,,Other,949.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,294.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,294.26,949.24, MRI THORACIC SPINE WOW CONTRAST,72157,HCPCS,612,RC,,,,both,4286.19,3000.33,,,,,,,,,,,,,,,,,,,Other,924.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,294.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,294.86,924.1, MRI LUMBAR WOW CONTRAST,72158,HCPCS,612,RC,,,,both,4402.76,3081.93,,,,,,,,,,,,,,,,,,,Other,949.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,294.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,294.56,949.24, MRI CHEST WITH CONTRAST,71551,HCPCS,614,RC,,,,both,3552.27,2486.59,,,,,,,,,,,,,,,,,,,Other,765.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,339.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,339.69,765.87, MRI CHEST WOW CONTRAST,71552,HCPCS,614,RC,,,,both,3723.94,2606.76,,,,,,,,,,,,,,,,,,,Other,802.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,426.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,426.78,802.88, MRI ABDOMEN WOW CONTRAST,74183,HCPCS,610,RC,,,,both,4194.09,2935.86,,,,,,,,,,,,,,,,,,,Other,904.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,310.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,310.17,904.25, MRI ABDOMEN WITH CONTRAST,74182,HCPCS,614,RC,,,,both,4364.59,3055.21,,,,,,,,,,,,,,,,,,,Other,941.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,276.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,276.04,941.01, MRI PELVIS WITH CONTRAST,72196,HCPCS,614,RC,,,,both,4299.55,3009.69,,,,,,,,,,,,,,,,,,,Other,926.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,247.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,247.34,926.98, MRI PELVIS WOW CONTRAST,72197,HCPCS,614,RC,,,,both,4774.04,3341.83,,,,,,,,,,,,,,,,,,,Other,1029.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,308.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,308.68,1029.28, "MRI SHOULDER JT RIGHT WOW CONTRAST,RIGHT",73223,HCPCS,610,RC,RT,,,both,4436.06,3105.24,,,,,,,,,,,,,,,,,,,Other,956.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,351.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,351.96,956.41, "MRI SHOULDER JT LEFT WOW CONTRAST,LEFT",73223,HCPCS,610,RC,LT,,,both,4657.99,3260.59,,,,,,,,,,,,,,,,,,,Other,1004.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,351.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,351.96,1004.26, "MRI ELBOW JT RIGHT WOW CONTRAST,RIGHT",73223,HCPCS,610,RC,RT,,,both,4076.71,2853.7,,,,,,,,,,,,,,,,,,,Other,878.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,351.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,351.96,878.94, "MRI ELBOW JT LEFT WOW CONTRAST,LEFT",73223,HCPCS,610,RC,LT,,,both,4076.71,2853.7,,,,,,,,,,,,,,,,,,,Other,878.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,351.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,351.96,878.94, MRI GREAT VESSELS WOW CONTRAST,71550,HCPCS,610,RC,,,,both,4970.43,3479.3,,,,,,,,,,,,,,,,,,,Other,1071.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,304.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,304.12,1071.62, "MRI UPPER EXTREMITY RIGHT WOW CONTRAST,RIGHT",73220,HCPCS,614,RC,RT,,,both,4435.16,3104.61,,,,,,,,,,,,,,,,,,,Other,956.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,373.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,373.39,956.23, "MRI UPPER EXTREMITY LEFT WOW CONTRAST,LEFT",73220,HCPCS,610,RC,LT,,,both,4435.16,3104.61,,,,,,,,,,,,,,,,,,,Other,956.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,373.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,373.39,956.23, "MRI KNEE LEFT WOW CONTRAST,LEFT",73723,HCPCS,614,RC,LT,,,both,4435.16,3104.61,,,,,,,,,,,,,,,,,,,Other,956.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,350.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,350.46,956.23, "MRI KNEE RIGHT WOW CONTRAST,RIGHT",73723,HCPCS,614,RC,RT,,,both,4435.16,3104.61,,,,,,,,,,,,,,,,,,,Other,956.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,350.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,350.46,956.23, "MRI KNEE RIGHT W CONTRAST,RIGHT",73722,HCPCS,614,RC,RT,,,both,3977.29,2784.1,,,,,,,,,,,,,,,,,,,Other,857.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,288.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,288.66,857.5, "MRI KNEE LEFT W CONTRAST,LEFT",73722,HCPCS,614,RC,LT,,,both,3977.29,2784.1,,,,,,,,,,,,,,,,,,,Other,857.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,288.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,288.66,857.5, "MRI HIP JT RIGHT WOW CONTRAST,RIGHT",73723,HCPCS,610,RC,RT,,,both,4435.16,3104.61,,,,,,,,,,,,,,,,,,,Other,956.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,350.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,350.46,956.23, "MRI HIP JT LEFT WOW CONTRAST,LEFT",73723,HCPCS,610,RC,LT,,,both,4435.16,3104.61,,,,,,,,,,,,,,,,,,,Other,956.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,350.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,350.46,956.23, "MRI HIP JT RIGHT W CONTRAST,RIGHT",73722,HCPCS,610,RC,RT,,,both,3977.29,2784.1,,,,,,,,,,,,,,,,,,,Other,857.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,288.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,288.66,857.5, "MRI HIP JT LEFT W CONTRAST,LEFT",73722,HCPCS,610,RC,LT,,,both,1780.58,1246.41,,,,,,,,,,,,,,,,,,,Other,383.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,288.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,288.66,383.9, MRI ANKLE JT LEFT WOW CONTRAST,73723,HCPCS,610,RC,,,,both,4435.16,3104.61,,,,,,,,,,,,,,,,,,,Other,956.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,350.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,350.46,956.23, MRI ANKLE JT RIGHT WOW CONTRAST,73723,HCPCS,610,RC,,,,both,4435.16,3104.61,,,,,,,,,,,,,,,,,,,Other,956.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,350.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,350.46,956.23, MRI ANKLE JT LEFT WO CONTRAST,73721,HCPCS,610,RC,,,,both,3854.68,2698.28,,,,,,,,,,,,,,,,,,,Other,831.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,188.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,188.57,831.07, MRI ANKLE JT RIGHT WO CONTRAST,73721,HCPCS,610,RC,,,,both,3854.75,2698.33,,,,,,,,,,,,,,,,,,,Other,831.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,188.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,188.57,831.09, BASIC METABOLIC PANEL POINT OF CARE,80048,HCPCS,301,RC,,,,both,131.88,92.32,,,,,,,,,,,,,,,,,,,Other,28.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.29,28.43, COMP METABOLIC PANEL POINT OF CARE,80053,HCPCS,301,RC,,,,both,250.4,175.28,,,,,,,,,,,,,,,,,,,Other,53.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.35,53.99, AMYLASE POINT OF CARE,82150,HCPCS,301,RC,,,,both,211.3,147.91,,,,,,,,,,,,,,,,,,,Other,45.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.35,45.56, CK POINT OF CARE,82550,HCPCS,301,RC,,,,both,86.2,60.34,,,,,,,,,,,,,,,,,,,Other,18.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.38,18.58, BACK UP CBC,85025,HCPCS,300,RC,,,,both,130,91,,,,,,,,,,,,,,,,,,,Other,28.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.61,28.03, CK-MB POINT OF CARE,82553,HCPCS,301,RC,,,,both,118.6,83.02,,,,,,,,,,,,,,,,,,,Other,25.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.32,25.57, TROPONIN POINT OF CARE,84484,HCPCS,301,RC,,,,both,179.2,125.44,,,,,,,,,,,,,,,,,,,Other,38.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.22,38.63, MYOGLOBIN POINT OF CARE,83874,HCPCS,301,RC,,,,both,162.2,113.54,,,,,,,,,,,,,,,,,,,Other,34.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.66,34.97, ORG ID REF LAB,87077,HCPCS,300,RC,,,,both,73.61,51.53,,,,,,,,,,,,,,,,,,,Other,15.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.92,15.87, URIC ACID POINT OF CARE,84550,HCPCS,301,RC,,,,both,59.66,41.76,,,,,,,,,,,,,,,,,,,Other,12.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.43,12.87, ELECTROLYTE PANEL,80051,HCPCS,301,RC,,,,both,82.97,58.08,,,,,,,,,,,,,,,,,,,Other,17.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.87,17.88, HEPATIC PANEL,80076,HCPCS,301,RC,,,,both,133.37,93.36,,,,,,,,,,,,,,,,,,,Other,28.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.01,28.75, EMPLOYEE CBC,85025,HCPCS,300,RC,,,,both,179.94,125.96,,,,,,,,,,,,,,,,,,,Other,38.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.61,38.8, EMPLOYEE URINALYSIS,81003,HCPCS,300,RC,,,,both,5.83,4.08,,,,,,,,,,,,,,,,,,,Other,1.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.25,2.2, EMPLOYEE NICOTINE SCREEN,80305,HCPCS,301,RC,,,,both,4.21,2.95,,,,,,,,,,,,,,,,,,,Other,0.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.91,4.13, EMPLOYEE NICOTINE CONFIRM,80323,HCPCS,300,RC,,,,both,22.65,15.86,,,,,,,,,,,,,,,,,,,Other,4.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.88,19.94, EMPLOYEE RUBELLA,86762,HCPCS,300,RC,,,,both,10.61,7.43,,,,,,,,,,,,,,,,,,,Other,2.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.28,10.4, EMPLOYEE RUBEOLA,86765,HCPCS,300,RC,,,,both,20.93,14.65,,,,,,,,,,,,,,,,,,,Other,4.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.51,12.62, EMPLOYEE MUMPS,86735,HCPCS,300,RC,,,,both,14.3,10.01,,,,,,,,,,,,,,,,,,,Other,3.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.09,12.79, EMPLOYEE VARICELLA,86787,HCPCS,300,RC,,,,both,13.64,9.55,,,,,,,,,,,,,,,,,,,Other,2.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.94,12.62, EMPLOYEE HEP B AB,86706,HCPCS,300,RC,,,,both,247.56,173.29,,,,,,,,,,,,,,,,,,,Other,53.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.53,53.37, EMPLOYEE QUANTIFERON TB,86480,HCPCS,300,RC,,,,both,64.26,44.98,,,,,,,,,,,,,,,,,,,Other,13.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,60.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.86,60.74, EMPLOYEE ALCOHOL,80320,HCPCS,301,RC,,,,both,21.34,14.94,,,,,,,,,,,,,,,,,,,Other,4.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.6,10.99, EMPLOYEE HIV 1/2,87389,HCPCS,300,RC,,,,both,18.96,13.27,,,,,,,,,,,,,,,,,,,Other,4.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.09,18.58, EMPLOYEE HEP B AG,87340,HCPCS,300,RC,,,,both,12.5,8.75,,,,,,,,,,,,,,,,,,,Other,2.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.7,10.12, EMPLOYEE HEP C AB,86803,HCPCS,300,RC,,,,both,13.57,9.5,,,,,,,,,,,,,,,,,,,Other,2.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.93,13.3, ALBUMIN SERUM,82040,HCPCS,301,RC,,,,both,50.24,35.17,,,,,,,,,,,,,,,,,,,Other,10.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.85,10.83, ALBUMIN REFERRED,82040,HCPCS,301,RC,,,,both,12.48,8.74,,,,,,,,,,,,,,,,,,,Other,2.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.7,4.85, "ALBUMIN URINE, OR OTHER SOURCES",82042,HCPCS,301,RC,,,,both,21.01,14.71,,,,,,,,,,,,,,,,,,,Other,4.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.53,7.62, COBALT BLOOD,83018,HCPCS,301,RC,,,,both,52.36,36.65,,,,,,,,,,,,,,,,,,,Other,11.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,21.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.29,21.52, CHROMIUM SERUM,82495,HCPCS,301,RC,,,,both,37.4,26.18,,,,,,,,,,,,,,,,,,,Other,8.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.07,19.87, IODINE URINE,83018,HCPCS,301,RC,,,,both,556.16,389.31,,,,,,,,,,,,,,,,,,,Other,119.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,21.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,21.52,119.91, ARSENIC FRACTIONATED,82175,HCPCS,301,RC,,,,both,258.4,180.88,,,,,,,,,,,,,,,,,,,Other,55.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.59,55.71, ARSENIC - QUANTITATIVE,82175,HCPCS,301,RC,,,,both,100.27,70.19,,,,,,,,,,,,,,,,,,,Other,21.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.59,21.62, CADMIUM - BLOOD,82300,HCPCS,301,RC,,,,both,116.84,81.79,,,,,,,,,,,,,,,,,,,Other,25.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.17,25.19, MUMPS AB IGM,86735,HCPCS,300,RC,,,,both,90.18,63.13,,,,,,,,,,,,,,,,,,,Other,19.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.79,19.44, B-19 PARVOVIRUS IGG,86747,HCPCS,302,RC,,,,both,64.07,44.85,,,,,,,,,,,,,,,,,,,Other,13.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.82,14.73, B-19 PARVOVIRUS IGM,86747,HCPCS,302,RC,,,,both,64.07,44.85,,,,,,,,,,,,,,,,,,,Other,13.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.82,14.73, BARTONELLA PCR,87801,HCPCS,302,RC,,,,both,266,186.2,,,,,,,,,,,,,,,,,,,Other,57.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,68.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,57.35,68.8, CMV IgM,86645,HCPCS,302,RC,,,,both,169,118.3,,,,,,,,,,,,,,,,,,,Other,36.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.51,36.44, LIPOPROTEIN (LITTLE A),83695,HCPCS,301,RC,,,,both,68.65,48.06,,,,,,,,,,,,,,,,,,,Other,14.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.03,14.8, AMYLASE SERUM,82150,HCPCS,301,RC,,,,both,211.3,147.91,,,,,,,,,,,,,,,,,,,Other,45.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.35,45.56, AMYLASE BODY FLUID,82150,HCPCS,301,RC,,,,both,93.79,65.65,,,,,,,,,,,,,,,,,,,Other,20.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.35,20.22, LIPASE-BODY FLUID,83690,HCPCS,301,RC,,,,both,103.6,72.52,,,,,,,,,,,,,,,,,,,Other,22.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.75,22.33, UREA NITROGEN SERUM,84520,HCPCS,301,RC,,,,both,50.24,35.17,,,,,,,,,,,,,,,,,,,Other,10.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.87,10.83, BLASTOMYCES AB-BY ID,86612,HCPCS,300,RC,,,,both,61.26,42.88,,,,,,,,,,,,,,,,,,,Other,13.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.64,13.21, RENAL FAILURE INDICIES 5,84540,HCPCS,301,RC,,,,both,18.5,12.95,,,,,,,,,,,,,,,,,,,Other,3.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.99,5.45, UREA NITROGEN URINE,84540,HCPCS,301,RC,,,,both,66.91,46.84,,,,,,,,,,,,,,,,,,,Other,14.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.45,14.43, UREA NITROGEN 24 HR URINE,84540,HCPCS,301,RC,,,,both,66.91,46.84,,,,,,,,,,,,,,,,,,,Other,14.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.45,14.43, AMYLASE URINE,82150,HCPCS,301,RC,,,,both,211.3,147.91,,,,,,,,,,,,,,,,,,,Other,45.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.35,45.56, ANGIOTENSIN I - CONVERTING ENZYME (ACE),82164,HCPCS,301,RC,,,,both,84.42,59.09,,,,,,,,,,,,,,,,,,,Other,18.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.31,18.2, TCO2 BICARBONATE,82374,HCPCS,301,RC,,,,both,36.3,25.41,,,,,,,,,,,,,,,,,,,Other,7.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.78,7.83, BILIRUBIN TOTAL,82247,HCPCS,301,RC,,,,both,50.24,35.17,,,,,,,,,,,,,,,,,,,Other,10.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.92,10.83, BILIRUBIN DIRECT,82248,HCPCS,301,RC,,,,both,50.91,35.64,,,,,,,,,,,,,,,,,,,Other,10.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.92,10.98, CALCIUM-SERUM,82310,HCPCS,301,RC,,,,both,50.24,35.17,,,,,,,,,,,,,,,,,,,Other,10.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.06,10.83, CHOLESTEROL TOTAL,82465,HCPCS,301,RC,,,,both,50.24,35.17,,,,,,,,,,,,,,,,,,,Other,10.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.26,10.83, CK SERUM,82550,HCPCS,301,RC,,,,both,86.2,60.34,,,,,,,,,,,,,,,,,,,Other,18.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.38,18.58, REFERRED CK,82550,HCPCS,301,RC,,,,both,86.2,60.34,,,,,,,,,,,,,,,,,,,Other,18.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.38,18.58, CREATININE-SERUM,82565,HCPCS,301,RC,,,,both,57.16,40.01,,,,,,,,,,,,,,,,,,,Other,12.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.02,12.33, CREATININE-BODY FLUI,82570,HCPCS,301,RC,,,,both,60.79,42.55,,,,,,,,,,,,,,,,,,,Other,13.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.08,13.1, CREATININE-URINE,82570,HCPCS,301,RC,,,,both,60.79,42.55,,,,,,,,,,,,,,,,,,,Other,13.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.08,13.1, CREATININE 24 HR URINE,82570,HCPCS,301,RC,,,,both,60.79,42.55,,,,,,,,,,,,,,,,,,,Other,13.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.08,13.1, RENAL FAILURE INDICIES 4,82570,HCPCS,301,RC,,,,both,18.5,12.95,,,,,,,,,,,,,,,,,,,Other,3.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.99,5.08, CREATININE CLEARANCE,82575,HCPCS,301,RC,,,,both,170.5,119.35,,,,,,,,,,,,,,,,,,,Other,36.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.27,36.76, GLUCOSE,82947,HCPCS,301,RC,,,,both,47.63,33.34,,,,,,,,,,,,,,,,,,,Other,10.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.85,10.27, CARNITINE,82379,HCPCS,301,RC,,,,both,211,147.7,,,,,,,,,,,,,,,,,,,Other,45.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.53,45.49, RENAL FAILURE INDICIES 3,82945,HCPCS,301,RC,,,,both,18.5,12.95,,,,,,,,,,,,,,,,,,,Other,3.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.85,3.99, GLUCOSE URINE,82945,HCPCS,301,RC,,,,both,50.24,35.17,,,,,,,,,,,,,,,,,,,Other,10.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.85,10.83, GLUCOSE 24 HR URINE,82945,HCPCS,301,RC,,,,both,21.62,15.13,,,,,,,,,,,,,,,,,,,Other,4.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.85,4.66, GLUCOSE BODY FLUID,82945,HCPCS,301,RC,,,,both,50.24,35.17,,,,,,,,,,,,,,,,,,,Other,10.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.85,10.83, GLUCOSE TLRNCE (1ST 3 SPEC.),82951,HCPCS,301,RC,,,,both,133.8,93.66,,,,,,,,,,,,,,,,,,,Other,28.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.61,28.85, GLUCOSE TOL SR HOUR 4,82952,HCPCS,301,RC,,,,both,21.62,15.13,,,,,,,,,,,,,,,,,,,Other,4.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.84,4.66, GLUCOSE TOL SR HOUR 5,82952,HCPCS,301,RC,,,,both,21.62,15.13,,,,,,,,,,,,,,,,,,,Other,4.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.84,4.66, "LACTIC ACID, ARTERIAL",83605,HCPCS,301,RC,,,,both,125.66,87.96,,,,,,,,,,,,,,,,,,,Other,27.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.34,27.1, "LACTIC ACID, VENOUS",83605,HCPCS,301,RC,,,,both,97.45,68.22,,,,,,,,,,,,,,,,,,,Other,21.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.34,21.01, LDH SERUM,83615,HCPCS,301,RC,,,,both,66.91,46.84,,,,,,,,,,,,,,,,,,,Other,14.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.92,14.43, LDH BODY FLUID,83615,HCPCS,301,RC,,,,both,66.91,46.84,,,,,,,,,,,,,,,,,,,Other,14.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.92,14.43, LACTOFERIN STOOL,83630,HCPCS,300,RC,,,,both,96.06,67.24,,,,,,,,,,,,,,,,,,,Other,20.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.31,20.71, "VIRAL SMEAR, SHELL VIAL",87254,HCPCS,300,RC,,,,both,178.38,124.87,,,,,,,,,,,,,,,,,,,Other,38.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.17,38.46, PHOSPHORUS URINE,84105,HCPCS,301,RC,,,,both,107.24,75.07,,,,,,,,,,,,,,,,,,,Other,23.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.66,23.12, PHOSPHORUS SERUM,84100,HCPCS,301,RC,,,,both,50.24,35.17,,,,,,,,,,,,,,,,,,,Other,10.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.65,10.83, PHOPHORUS 24 HR URINE,84105,HCPCS,301,RC,,,,both,52.17,36.52,,,,,,,,,,,,,,,,,,,Other,11.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.66,11.25, POTASSIUM URINE,84133,HCPCS,301,RC,,,,both,55.42,38.79,,,,,,,,,,,,,,,,,,,Other,11.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.64,11.95, POTASSIUM 24 HR URINE,84133,HCPCS,301,RC,,,,both,53.29,37.3,,,,,,,,,,,,,,,,,,,Other,11.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.64,11.49, POTASSIUM BLOOD,84132,HCPCS,301,RC,,,,both,53.3,37.31,,,,,,,,,,,,,,,,,,,Other,11.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.66,11.5, PREALBUMIN,84134,HCPCS,301,RC,,,,both,88.77,62.14,,,,,,,,,,,,,,,,,,,Other,19.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.3,19.14, POTASSIUM BLOOD GAS,84132,HCPCS,301,RC,,,,both,53.3,37.31,,,,,,,,,,,,,,,,,,,Other,11.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.66,11.5, PLATELET FUNCTION ASSAY,85576,HCPCS,301,RC,,,,both,372,260.4,,,,,,,,,,,,,,,,,,,Other,80.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,80.2,80.2, IODINE SERUM,83789,HCPCS,301,RC,,,,both,132,92.4,,,,,,,,,,,,,,,,,,,Other,28.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.63,28.46, OSMOLALITY SERUM MEASURED,83930,HCPCS,301,RC,,,,both,31.55,22.09,,,,,,,,,,,,,,,,,,,Other,6.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.48,6.8, OSMOLALITY URINE MEASURED,83935,HCPCS,301,RC,,,,both,45.58,31.91,,,,,,,,,,,,,,,,,,,Other,9.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.68,9.83, PH BODY FLUID,83986,HCPCS,301,RC,,,,both,59.88,41.92,,,,,,,,,,,,,,,,,,,Other,12.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.51,12.91, NICKLE URINE 24 HOUR,83885,HCPCS,301,RC,,,,both,1168.86,818.2,,,,,,,,,,,,,,,,,,,Other,252.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.02,252.01, VIT B2 RIBOFLAVIN,84252,HCPCS,301,RC,,,,both,68.87,48.21,,,,,,,,,,,,,,,,,,,Other,14.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.85,19.84, MYELINE OLIOGODENDROCYTE GLYCOPROTEIN,86363,HCPCS,301,RC,,,,both,1485,1039.5,,,,,,,,,,,,,,,,,,,Other,320.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.98,320.17, Babesia PCR,87469,HCPCS,301,RC,,,,both,249,174.3,,,,,,,,,,,,,,,,,,,Other,53.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.39,53.68, AST SERUM,84450,HCPCS,301,RC,,,,both,50.24,35.17,,,,,,,,,,,,,,,,,,,Other,10.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.08,10.83, ALT SERUM,84460,HCPCS,301,RC,,,,both,50.24,35.17,,,,,,,,,,,,,,,,,,,Other,10.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.19,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.19,10.83, ESTROGEN SERUM FRACTION,82671,HCPCS,301,RC,,,,both,215.29,150.7,,,,,,,,,,,,,,,,,,,Other,46.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,31.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.65,46.41, GAMMA GT,82977,HCPCS,301,RC,,,,both,50.82,35.57,,,,,,,,,,,,,,,,,,,Other,10.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.06,10.96, LYSOZYME MURAMIDASE,85549,HCPCS,309,RC,,,,both,200.83,140.58,,,,,,,,,,,,,,,,,,,Other,43.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.38,43.3, SODIUM BLOOD,84295,HCPCS,301,RC,,,,both,50.24,35.17,,,,,,,,,,,,,,,,,,,Other,10.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.71,10.83, SODIUM BF,84302,HCPCS,301,RC,,,,both,50.24,35.17,,,,,,,,,,,,,,,,,,,Other,10.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.76,10.83, SODIUM BLOOD GAS,84295,HCPCS,301,RC,,,,both,50.24,35.17,,,,,,,,,,,,,,,,,,,Other,10.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.71,10.83, COMPLEMENT TOTAL (CH50),86162,HCPCS,300,RC,,,,both,103.35,72.35,,,,,,,,,,,,,,,,,,,Other,22.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.91,22.29, PROTEIN TOTAL,84155,HCPCS,301,RC,,,,both,95.3,66.71,,,,,,,,,,,,,,,,,,,Other,20.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.6,20.55, TOTAL PROTEIN REF LAB,84155,HCPCS,301,RC,,,,both,47.63,33.34,,,,,,,,,,,,,,,,,,,Other,10.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.6,10.27, URIC ACID SERUM,84550,HCPCS,301,RC,,,,both,59.66,41.76,,,,,,,,,,,,,,,,,,,Other,12.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.43,12.87, URIC ACID BF/URINE,84560,HCPCS,301,RC,,,,both,50.37,35.26,,,,,,,,,,,,,,,,,,,Other,10.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.98,10.86, URIC ACID 24 HR URINE,84560,HCPCS,301,RC,,,,both,50.37,35.26,,,,,,,,,,,,,,,,,,,Other,10.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.98,10.86, HISTAMINE,83088,HCPCS,301,RC,,,,both,495,346.5,,,,,,,,,,,,,,,,,,,Other,106.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,28.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,28.94,106.72, P TAU 181,83520,HCPCS,301,RC,,,,both,686.4,480.48,,,,,,,,,,,,,,,,,,,Other,147.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.92,147.99, P TAU 217,83520,HCPCS,301,RC,,,,both,1299.24,909.47,,,,,,,,,,,,,,,,,,,Other,280.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.92,280.11, BLEEDING TIME,85002,HCPCS,300,RC,,,,both,114.52,80.16,,,,,,,,,,,,,,,,,,,Other,24.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.72,24.69, BETA-D-GLYCAN,87449,HCPCS,300,RC,,,,both,470.57,329.4,,,,,,,,,,,,,,,,,,,Other,101.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.74,101.46, PHOSPHATIDYLETHANOL,80321,HCPCS,300,RC,,,,both,239,167.3,,,,,,,,,,,,,,,,,,,Other,51.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.2,51.53, NMO IGG AB,86053,HCPCS,300,RC,,,,both,876.15,613.31,,,,,,,,,,,,,,,,,,,Other,188.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.98,188.9, SACCROMYCES CERVEISIAE AB,86671,HCPCS,300,RC,,,,both,945.52,661.86,,,,,,,,,,,,,,,,,,,Other,203.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12,203.85, JAK2 EXON 12,81403,HCPCS,310,RC,,,,both,1186.46,830.52,,,,,,,,,,,,,,,,,,,Other,255.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,181.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,181.5,255.8, TPMT GENETICS,81401,HCPCS,310,RC,,,,both,1120.27,784.19,,,,,,,,,,,,,,,,,,,Other,241.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,134.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,134.26,241.53, KRAS VAREXON,81403,HCPCS,310,RC,,,,both,376.34,263.44,,,,,,,,,,,,,,,,,,,Other,81.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,181.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,81.13,181.5, KRAS GENE ANALYSIS,81275,HCPCS,310,RC,,,,both,839.38,587.57,,,,,,,,,,,,,,,,,,,Other,180.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,189.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,180.97,189.38, HEMOCHROMATOSIS HFE 3 MUTATIONS,81256,HCPCS,310,RC,,,,both,278.72,195.1,,,,,,,,,,,,,,,,,,,Other,60.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,64.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.09,64.05, MTHFR,81291,HCPCS,310,RC,,,,both,270.38,189.27,,,,,,,,,,,,,,,,,,,Other,58.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,64.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,58.29,64.03, PROTHROMBIN GENE MUTATION,81240,HCPCS,310,RC,,,,both,297.03,207.92,,,,,,,,,,,,,,,,,,,Other,64.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,64.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,64.04,64.38, FACTOR V LEIDEN I,81241,HCPCS,310,RC,,,,both,261.74,183.22,,,,,,,,,,,,,,,,,,,Other,56.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,71.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,56.43,71.9, JAK 2 GENE ANALYSIS,81270,HCPCS,310,RC,,,,both,438.17,306.72,,,,,,,,,,,,,,,,,,,Other,94.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,89.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,89.83,94.47, CYTOGENETICS DNA PROBE FISH MDS,88271,HCPCS,311,RC,,,,both,295.62,206.93,,,,,,,,,,,,,,,,,,,Other,63.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.99,63.74, MOLECULAR CYTOGENETICS DNA PROBE,88271,HCPCS,311,RC,,,,both,300.71,210.5,,,,,,,,,,,,,,,,,,,Other,64.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.99,64.84, INSITU HYBRID MORPHOMETRIC MANUAL,88368,HCPCS,310,RC,,,,both,800.53,560.37,,,,,,,,,,,,,,,,,,,Other,133.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,133.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,133.68,133.68, MOLECULAR CYTOGENETICS FISH 10-30,88273,HCPCS,311,RC,,,,both,180.54,126.38,,,,,,,,,,,,,,,,,,,Other,38.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.11,38.93, INSITU HYBRID MORPHOMETRIC AUTO,88364,HCPCS,310,RC,,,,both,423.28,296.3,,,,,,,,,,,,,,,,,,,Other,115.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,115.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,115.63,115.63, MICRODISSECTION NAMUAL,88381,HCPCS,310,RC,,,,both,70.1,49.07,,,,,,,,,,,,,,,,,,,Other,170.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,68.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,68.7,170.5, ALK MORPHOMETRIC ANALYSIS,88368,HCPCS,310,RC,,,,both,742.42,519.69,,,,,,,,,,,,,,,,,,,Other,133.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,133.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,133.68,133.68, EGFR GENE ANALYSIS,81235,HCPCS,310,RC,,,,both,1263,884.1,,,,,,,,,,,,,,,,,,,Other,272.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,318.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,272.3,318.09, MSI ANALYSIS,81301,HCPCS,310,RC,,,,both,537.49,376.24,,,,,,,,,,,,,,,,,,,Other,115.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,341.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,115.88,341.59, DGP IGG,83516,HCPCS,300,RC,,,,both,72.14,50.5,,,,,,,,,,,,,,,,,,,Other,15.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.3,15.55, BCR ABL BY PCR,81206,HCPCS,310,RC,,,,both,1268.13,887.69,,,,,,,,,,,,,,,,,,,Other,273.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,160.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,160.68,273.41, BRCA 1 AND 2,81162,HCPCS,310,RC,,,,both,6207.57,4345.3,,,,,,,,,,,,,,,,,,,Other,1338.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1788.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1338.36,1788.38, ERYTHROPOIETIN,82668,HCPCS,301,RC,,,,both,246,172.2,,,,,,,,,,,,,,,,,,,Other,53.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.41,53.04, MOLECULAR CYTO DNA PROBE-MAYO,88271,HCPCS,311,RC,,,,both,1981.18,1386.83,,,,,,,,,,,,,,,,,,,Other,427.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.99,427.14, CYTO DNA PROBE BALLF,88271,HCPCS,311,RC,,,,both,512.66,358.86,,,,,,,,,,,,,,,,,,,Other,110.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.99,110.53, HPV DNA IGH RISK TYPES,G0476,HCPCS,311,RC,,,,both,119.03,83.32,,,,,,,,,,,,,,,,,,,Other,25.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,25.67,34.39, ARCHIVAL TISSUE MOLECULAR,88363,HCPCS,310,RC,,,,both,45.58,31.91,,,,,,,,,,,,,,,,,,,Other,21.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,21.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,21.78,21.78, FISH PLASMA CELL MAYO,88271,HCPCS,311,RC,,,,both,803.33,562.33,,,,,,,,,,,,,,,,,,,Other,173.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.99,173.2, VON WILLIBRAND FACTOR COLLAGEN BINDING A,85246,HCPCS,311,RC,,,,both,560.39,392.27,,,,,,,,,,,,,,,,,,,Other,120.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,22.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,22.48,120.82, GBM GLOM BASEMENT MEMBRANE,83516,HCPCS,301,RC,,,,both,19.04,13.33,,,,,,,,,,,,,,,,,,,Other,4.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.11,11.3, MISC MOL CYTO DNA PROBE,88271,HCPCS,311,RC,,,,both,74.46,52.12,,,,,,,,,,,,,,,,,,,Other,16.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.05,20.99, EOSINOPHIL COUNT NASAL,89190,HCPCS,300,RC,,,,both,51.95,36.37,,,,,,,,,,,,,,,,,,,Other,11.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.67,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.67,11.2, EOSINOPHILS URINE,81015,HCPCS,300,RC,,,,both,11.1,7.77,,,,,,,,,,,,,,,,,,,Other,2.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.39,2.99, URINE MICROSCOPIC,81015,HCPCS,300,RC,,,,both,15.5,10.85,,,,,,,,,,,,,,,,,,,Other,3.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.99,3.34, PROTOZOA ANTIBODY,86753,HCPCS,300,RC,,,,both,103,72.1,,,,,,,,,,,,,,,,,,,Other,22.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.14,22.21, ERLICHIA ANTIOBODY,86666,HCPCS,300,RC,,,,both,291.49,204.04,,,,,,,,,,,,,,,,,,,Other,62.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.98,62.85, ANAPLASMA ANTIBODY,86666,HCPCS,300,RC,,,,both,291.49,204.04,,,,,,,,,,,,,,,,,,,Other,62.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.98,62.85, HEPARIN ANTI-XA,85520,HCPCS,300,RC,,,,both,78.58,55.01,,,,,,,,,,,,,,,,,,,Other,16.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.83,16.94, FIBRINOGEN,85384,HCPCS,300,RC,,,,both,130.29,91.2,,,,,,,,,,,,,,,,,,,Other,28.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.53,28.09, FACTOR VWF GPIBM,85397,HCPCS,305,RC,,,,both,353.7,247.59,,,,,,,,,,,,,,,,,,,Other,76.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.24,76.25, INSULIN LIKE GROWTH FACTOR BP3,83520,HCPCS,305,RC,,,,both,275,192.5,,,,,,,,,,,,,,,,,,,Other,59.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.92,59.29, ANTI HMG COA REDUCTASE,82397,HCPCS,301,RC,,,,both,429,300.3,,,,,,,,,,,,,,,,,,,Other,92.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.84,92.49, HEMATOCRIT X,85014,HCPCS,300,RC,,,,both,18.41,12.89,,,,,,,,,,,,,,,,,,,Other,3.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.32,3.97, HEMOGLOBIN X,85018,HCPCS,300,RC,,,,both,37.43,26.2,,,,,,,,,,,,,,,,,,,Other,8.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.32,8.07, HEMOGLOBIN - PLASMA,83051,HCPCS,300,RC,,,,both,99.27,69.49,,,,,,,,,,,,,,,,,,,Other,21.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.16,21.4, HEMOGLOBIN BLOOD GAS,85018,HCPCS,300,RC,,,,both,37.43,26.2,,,,,,,,,,,,,,,,,,,Other,8.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.32,8.07, SOMATOSTATIN,84307,HCPCS,300,RC,,,,both,676.5,473.55,,,,,,,,,,,,,,,,,,,Other,145.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.91,145.85, ZINC URINE 24 HOUR,84630,HCPCS,300,RC,,,,both,665.94,466.16,,,,,,,,,,,,,,,,,,,Other,143.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.16,143.58, WBC X,85048,HCPCS,300,RC,,,,both,27.76,19.43,,,,,,,,,,,,,,,,,,,Other,5.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.49,5.99, HIV I RNA QUANT PCR,87536,HCPCS,300,RC,,,,both,823.8,576.66,,,,,,,,,,,,,,,,,,,Other,177.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,83.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,83.4,177.62, FILARIA BLOOD,87210,HCPCS,300,RC,,,,both,864.6,605.22,,,,,,,,,,,,,,,,,,,Other,186.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.7,186.41, PLATELET COUNT X,85049,HCPCS,300,RC,,,,both,31.26,21.88,,,,,,,,,,,,,,,,,,,Other,6.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.39,6.74, PLATELET COUNT-MAN,85032,HCPCS,300,RC,,,,both,73.73,51.61,,,,,,,,,,,,,,,,,,,Other,15.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.22,15.9, PLASMA FROZEN WITHIN 24 HOURS,P9059,HCPCS,390,RC,,,,both,259.33,181.53,,,,,,,,,,,,,,,,,,,Other,55.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,55.91,55.91, RENIN LEVEL,84244,HCPCS,301,RC,,,,both,118.3,82.81,,,,,,,,,,,,,,,,,,,Other,25.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,21.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,21.55,25.51, SOLUBLE TRANSFERRIN RECEPTOR,84238,HCPCS,300,RC,,,,both,86.16,60.31,,,,,,,,,,,,,,,,,,,Other,18.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,35.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.58,35.84, HEXAGONAL PHASE PHOSPHOLIPID,85597,HCPCS,305,RC,,,,both,77.71,54.4,,,,,,,,,,,,,,,,,,,Other,16.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.76,17.62, PT(PROTHROMBIN TIME),85610,HCPCS,300,RC,,,,both,56.71,39.7,,,,,,,,,,,,,,,,,,,Other,12.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.2,12.23, THROMBIN TIME,85670,HCPCS,300,RC,,,,both,58.71,41.1,,,,,,,,,,,,,,,,,,,Other,12.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.65,12.66, DILUTE RUSSELL VIPER VENOM TIME,85613,HCPCS,300,RC,,,,both,91.91,64.34,,,,,,,,,,,,,,,,,,,Other,19.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.39,19.82, PT MIXING STUDY,85611,HCPCS,300,RC,,,,both,20.16,14.11,,,,,,,,,,,,,,,,,,,Other,4.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.86,4.35, PTT PARTL THRMBPLSTN,85730,HCPCS,300,RC,,,,both,88.34,61.84,,,,,,,,,,,,,,,,,,,Other,19.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.89,19.04, APC RESISTANCE PROFILE,85307,HCPCS,300,RC,,,,both,109.26,76.48,,,,,,,,,,,,,,,,,,,Other,23.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.01,23.56, APTT MIXING STUDY,85732,HCPCS,300,RC,,,,both,33.01,23.11,,,,,,,,,,,,,,,,,,,Other,7.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.34,7.11, VISCOSITY,85810,HCPCS,300,RC,,,,both,77.1,53.97,,,,,,,,,,,,,,,,,,,Other,16.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.44,16.62, SYPHILIS AB BY TPPA,86780,HCPCS,300,RC,,,,both,127.49,89.24,,,,,,,,,,,,,,,,,,,Other,27.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.98,27.49, RETICULOCYTE COUNT,85045,HCPCS,300,RC,,,,both,99.27,69.49,,,,,,,,,,,,,,,,,,,Other,21.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.91,21.4, RA FACTOR-FLUID,86430,HCPCS,300,RC,,,,both,75.99,53.19,,,,,,,,,,,,,,,,,,,Other,16.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.02,16.39, SCL-70 AB,86235,HCPCS,302,RC,,,,both,22.41,15.69,,,,,,,,,,,,,,,,,,,Other,4.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.83,17.57, SED RATE ESR,85652,HCPCS,300,RC,,,,both,82,57.4,,,,,,,,,,,,,,,,,,,Other,17.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.65,17.68, SICKLE CELL SCREEN,85660,HCPCS,300,RC,,,,both,18.26,12.78,,,,,,,,,,,,,,,,,,,Other,3.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.94,5.4, ANTI PM/SCL-100,83516,HCPCS,301,RC,,,,both,310.07,217.05,,,,,,,,,,,,,,,,,,,Other,66.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.3,66.86, RPR QUANT,86593,HCPCS,300,RC,,,,both,69.23,48.46,,,,,,,,,,,,,,,,,,,Other,14.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.31,14.93, RPR QUAL,86592,HCPCS,300,RC,,,,both,52,36.4,,,,,,,,,,,,,,,,,,,Other,11.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.18,11.21, RSV,87420,HCPCS,300,RC,,,,both,72.14,50.5,,,,,,,,,,,,,,,,,,,Other,15.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.63,15.55, ACYLCARNITES PLASMA QUANT,82017,HCPCS,300,RC,,,,both,372,260.4,,,,,,,,,,,,,,,,,,,Other,80.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.53,80.2, AMINO ACID QUANT PLASMA,82139,HCPCS,300,RC,,,,both,596,417.2,,,,,,,,,,,,,,,,,,,Other,128.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.53,128.5, COLLAGEN CROSS LINKS,82523,HCPCS,301,RC,,,,both,275,192.5,,,,,,,,,,,,,,,,,,,Other,59.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.31,59.29, MONO TEST,86308,HCPCS,300,RC,,,,both,78.26,54.78,,,,,,,,,,,,,,,,,,,Other,16.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.08,16.88, CYSTIC FIBROSIS MUTATION,81220,HCPCS,300,RC,,,,both,1230.75,861.53,,,,,,,,,,,,,,,,,,,Other,265.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,545.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,265.35,545.47, CHIKINGUNYA PCR SERUM,87798,HCPCS,300,RC,,,,both,268,187.6,,,,,,,,,,,,,,,,,,,Other,57.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.39,57.78, DENGUE FEVER PCR,87798,HCPCS,300,RC,,,,both,1032.9,723.03,,,,,,,,,,,,,,,,,,,Other,222.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.39,222.7, ASO TITER,83883,HCPCS,300,RC,,,,both,241.02,168.71,,,,,,,,,,,,,,,,,,,Other,51.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.33,51.96, RAST TEST (ALLERGEN),86003,HCPCS,300,RC,,,,both,33.34,23.34,,,,,,,,,,,,,,,,,,,Other,7.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.12,7.18, GALACTOSE ALPHA ALLERGEN,86003,HCPCS,302,RC,,,,both,83.38,58.37,,,,,,,,,,,,,,,,,,,Other,17.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.12,17.97, ALLERGEN PENICILLIN,86003,HCPCS,300,RC,,,,both,83.38,58.37,,,,,,,,,,,,,,,,,,,Other,17.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.12,17.97, ALLERGEN APPLE,86003,HCPCS,300,RC,,,,both,83.38,58.37,,,,,,,,,,,,,,,,,,,Other,17.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.12,17.97, ALLERGENS BRAZIL NUT,86003,HCPCS,300,RC,,,,both,83.38,58.37,,,,,,,,,,,,,,,,,,,Other,17.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.12,17.97, ALLERGENS PISTACHIO,86003,HCPCS,300,RC,,,,both,33.34,23.34,,,,,,,,,,,,,,,,,,,Other,7.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.12,7.18, RBC LEUKOCYTES REDUCED,P9016,HCPCS,390,RC,,,,both,700.06,490.04,,,,,,,,,,,,,,,,,,,Other,150.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,150.93,150.93, RBC LEUKOREDUCED IRRADIATED,P9040,HCPCS,390,RC,,,,both,1016.35,711.45,,,,,,,,,,,,,,,,,,,Other,219.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,219.13,219.13, RA TITER QUANT,86431,HCPCS,300,RC,,,,both,81.48,57.04,,,,,,,,,,,,,,,,,,,Other,17.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.56,17.57, RA FACTOR QUAL,86430,HCPCS,300,RC,,,,both,75.99,53.19,,,,,,,,,,,,,,,,,,,Other,16.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.02,16.39, COLD AGGLUTININS,86157,HCPCS,300,RC,,,,both,70.7,49.49,,,,,,,,,,,,,,,,,,,Other,15.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.9,15.24, COPPER SERUM,82525,HCPCS,301,RC,,,,both,72.14,50.5,,,,,,,,,,,,,,,,,,,Other,15.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.16,15.55, SELENIUM,84255,HCPCS,301,RC,,,,both,116.51,81.56,,,,,,,,,,,,,,,,,,,Other,25.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,25.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,25.02,25.12, COPPER URINE,82525,HCPCS,301,RC,,,,both,146.06,102.24,,,,,,,,,,,,,,,,,,,Other,31.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.16,31.49, BP 180 ANTIBODIES BULLOUS PEMPHIGOID,83516,HCPCS,301,RC,,,,both,189.75,132.83,,,,,,,,,,,,,,,,,,,Other,40.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.3,40.92, BP 230 ANTIBODIES BULLOUS PEMPHIGOID,83516,HCPCS,301,RC,,,,both,189.75,132.83,,,,,,,,,,,,,,,,,,,Other,40.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.3,40.92, FREE FATTY ACIDS SERUM,82725,HCPCS,300,RC,,,,both,98,68.6,,,,,,,,,,,,,,,,,,,Other,21.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.39,21.13, MUMPS ANTIBODY IGG,86735,HCPCS,300,RC,,,,both,41.19,28.83,,,,,,,,,,,,,,,,,,,Other,8.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.88,12.79, PREG TEST(UCG)UR,81025,HCPCS,301,RC,,,,both,114.56,80.19,,,,,,,,,,,,,,,,,,,Other,24.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.44,24.7, PREG TEST (HCG) SER,84703,HCPCS,301,RC,,,,both,114.56,80.19,,,,,,,,,,,,,,,,,,,Other,24.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.37,24.7, URINALYSIS C/S IF INDICATED,81003,HCPCS,300,RC,,,,both,42.93,30.05,,,,,,,,,,,,,,,,,,,Other,9.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.2,9.25, URINE VOLUME,81050,HCPCS,300,RC,,,,both,24.54,17.18,,,,,,,,,,,,,,,,,,,Other,5.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.57,5.29, PINWORMS TAPE TEST,87172,HCPCS,300,RC,,,,both,58.43,40.9,,,,,,,,,,,,,,,,,,,Other,12.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.18,12.59, PARASITE MACROSCOPIC,87169,HCPCS,306,RC,,,,both,29.09,20.36,,,,,,,,,,,,,,,,,,,Other,6.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.22,6.27, "PLATELETS, PHERESIS",P9035,HCPCS,390,RC,,,,both,2066.22,1446.35,,,,,,,,,,,,,,,,,,,Other,445.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,445.48,445.48, GIARDIA AG,87329,HCPCS,300,RC,,,,both,91.44,64.01,,,,,,,,,,,,,,,,,,,Other,19.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.74,19.72, METHYLMALONIC ACID,83921,HCPCS,301,RC,,,,both,188.73,132.11,,,,,,,,,,,,,,,,,,,Other,40.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.79,40.69, "BLD OCCULT FECAL IMMUNO CHEMICAL,CLIA WAIVED",82274,HCPCS,300,RC,QW,,,both,116.69,81.68,,,,,,,,,,,,,,,,,,,Other,25.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.6,25.16, BLD OCCULT FECAL IMMUNO DIAGNOSTIC,82274,HCPCS,300,RC,,,,both,79.39,55.57,,,,,,,,,,,,,,,,,,,Other,17.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.6,17.12, TRICHROME STAIN,87209,HCPCS,300,RC,,,,both,94.38,66.07,,,,,,,,,,,,,,,,,,,Other,20.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.62,20.34, GRAM STAIN,87205,HCPCS,306,RC,,,,both,64.65,45.26,,,,,,,,,,,,,,,,,,,Other,13.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.18,13.94, CHLAMYDIA TRACH OMATIS DFA,87270,HCPCS,300,RC,,,,both,92.13,64.49,,,,,,,,,,,,,,,,,,,Other,19.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.74,19.86, OVA & PARASITE SMEAR-DIRECT,87177,HCPCS,300,RC,,,,both,57.25,40.08,,,,,,,,,,,,,,,,,,,Other,12.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.72,12.35, "SMOOTH MUSCLE AB, IGG",86255,HCPCS,300,RC,,,,both,59.62,41.73,,,,,,,,,,,,,,,,,,,Other,12.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.86,12.86, SMOOTH MUSCLE TITER,86256,HCPCS,300,RC,,,,both,61.64,43.15,,,,,,,,,,,,,,,,,,,Other,13.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.29,13.29, RETUCULIN AB IGA,86255,HCPCS,300,RC,,,,both,97.46,68.22,,,,,,,,,,,,,,,,,,,Other,21.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,21.01,21.01, AGNA 1,86255,HCPCS,302,RC,,,,both,219.8,153.86,,,,,,,,,,,,,,,,,,,Other,47.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.39,47.39, AMPHIPHYSIN,86255,HCPCS,302,RC,,,,both,219.8,153.86,,,,,,,,,,,,,,,,,,,Other,47.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.39,47.39, ANNA 1,86255,HCPCS,302,RC,,,,both,219.8,153.86,,,,,,,,,,,,,,,,,,,Other,47.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.39,47.39, ANNA 2,86255,HCPCS,302,RC,,,,both,219.8,153.86,,,,,,,,,,,,,,,,,,,Other,47.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.39,47.39, ANNA 3,86255,HCPCS,302,RC,,,,both,219.8,153.86,,,,,,,,,,,,,,,,,,,Other,47.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.39,47.39, CRMP 5 IGG,86255,HCPCS,302,RC,,,,both,219.8,153.86,,,,,,,,,,,,,,,,,,,Other,47.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.39,47.39, PCA 1,86255,HCPCS,302,RC,,,,both,226.39,158.47,,,,,,,,,,,,,,,,,,,Other,48.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,48.81,48.81, PCA 2,86255,HCPCS,302,RC,,,,both,226.39,158.47,,,,,,,,,,,,,,,,,,,Other,48.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,48.81,48.81, PCA TR,86255,HCPCS,302,RC,,,,both,226.39,158.47,,,,,,,,,,,,,,,,,,,Other,48.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,48.81,48.81, ENDOMYSIAL AB,86255,HCPCS,302,RC,,,,both,186.09,130.26,,,,,,,,,,,,,,,,,,,Other,40.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.12,40.12, SENSI ENZYME DIRECT,87185,HCPCS,306,RC,,,,both,10.24,7.17,,,,,,,,,,,,,,,,,,,Other,2.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.2,4.66, SENSITIVITY ORGANISM 1,87184,HCPCS,300,RC,,,,both,88.46,61.92,,,,,,,,,,,,,,,,,,,Other,19.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.33,19.07, REF SUSCEPTIBILITY,87186,HCPCS,300,RC,,,,both,84.42,59.09,,,,,,,,,,,,,,,,,,,Other,18.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.48,18.2, SUSCEPT SLOW GROWER,87186,HCPCS,306,RC,,,,both,759.52,531.66,,,,,,,,,,,,,,,,,,,Other,163.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.48,163.75, Monkeypox PCR,87593,HCPCS,306,RC,,,,both,305.91,214.14,,,,,,,,,,,,,,,,,,,Other,65.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,50.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,50.28,65.95, CULTURE-STREP ONLY,87081,HCPCS,300,RC,,,,both,86.6,60.62,,,,,,,,,,,,,,,,,,,Other,18.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.5,18.67, SUSCEPTIBILITY 1,87186,HCPCS,306,RC,,,,both,84.42,59.09,,,,,,,,,,,,,,,,,,,Other,18.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.48,18.2, SUSCEPTIBILITY 2,87186,HCPCS,306,RC,,,,both,99.46,69.62,,,,,,,,,,,,,,,,,,,Other,21.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.48,21.44, SENSITIVITY REFERRED,87181,HCPCS,306,RC,,,,both,57.05,39.94,,,,,,,,,,,,,,,,,,,Other,12.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.66,12.3, BETA-2-MICRGLBLN SER,82232,HCPCS,301,RC,,,,both,88.77,62.14,,,,,,,,,,,,,,,,,,,Other,19.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.86,19.14, STREP A ANTIGEN,87880,HCPCS,300,RC,,,,both,73.73,51.61,,,,,,,,,,,,,,,,,,,Other,15.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.9,16.2, CULTURE-EXUDATE/WND,87070,HCPCS,300,RC,,,,both,127.04,88.93,,,,,,,,,,,,,,,,,,,Other,27.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.45,27.39, CULTURE-TISSUE,87070,HCPCS,300,RC,,,,both,127.04,88.93,,,,,,,,,,,,,,,,,,,Other,27.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.45,27.39, CULTURE-ANAEROBIC,87075,HCPCS,300,RC,,,,both,180.59,126.41,,,,,,,,,,,,,,,,,,,Other,38.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.28,38.94, CULTURE BLOOD 1,87040,HCPCS,300,RC,,,,both,171.77,120.24,,,,,,,,,,,,,,,,,,,Other,37.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.11,37.03, CULTURE BLOOD 2,87040,HCPCS,300,RC,,,,both,121.24,84.87,,,,,,,,,,,,,,,,,,,Other,26.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.11,26.14, CULTURE-BRONC WASH,87070,HCPCS,300,RC,,,,both,127.04,88.93,,,,,,,,,,,,,,,,,,,Other,27.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.45,27.39, CULTURE-MRSA PRE OP,87081,HCPCS,306,RC,,,,both,101.13,70.79,,,,,,,,,,,,,,,,,,,Other,21.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.5,21.8, CULTURE MRSA SURVEILLANCE,87081,HCPCS,300,RC,,,,both,86.6,60.62,,,,,,,,,,,,,,,,,,,Other,18.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.5,18.67, CULTURE - LEGIONELLA,87081,HCPCS,300,RC,,,,both,90.58,63.41,,,,,,,,,,,,,,,,,,,Other,19.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.5,19.53, CULTURE VRE,87081,HCPCS,300,RC,,,,both,86.6,60.62,,,,,,,,,,,,,,,,,,,Other,18.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.5,18.67, FROZEN COMPONENT THAWING,86927,HCPCS,300,RC,,,,both,764.69,535.28,,,,,,,,,,,,,,,,,,,Other,164.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,164.87,164.87, CULTURE UROGENITAL,87070,HCPCS,300,RC,,,,both,127.04,88.93,,,,,,,,,,,,,,,,,,,Other,27.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.45,27.39, CULTURE VRE SCREEN,87081,HCPCS,300,RC,,,,both,86.6,60.62,,,,,,,,,,,,,,,,,,,Other,18.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.5,18.67, CULTURE-SPUTUM,87070,HCPCS,300,RC,,,,both,127.04,88.93,,,,,,,,,,,,,,,,,,,Other,27.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.45,27.39, CULTURE-SPINAL FLUID,87070,HCPCS,300,RC,,,,both,127.04,88.93,,,,,,,,,,,,,,,,,,,Other,27.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.45,27.39, CULTURE-EAR,87070,HCPCS,300,RC,,,,both,127.04,88.93,,,,,,,,,,,,,,,,,,,Other,27.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.45,27.39, CULTURE-EYE,87070,HCPCS,300,RC,,,,both,127.04,88.93,,,,,,,,,,,,,,,,,,,Other,27.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.45,27.39, CULTURE-URINE,87086,HCPCS,306,RC,,,,both,94.88,66.42,,,,,,,,,,,,,,,,,,,Other,20.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.91,20.45, CULTURE-THROAT,87070,HCPCS,300,RC,,,,both,127.04,88.93,,,,,,,,,,,,,,,,,,,Other,27.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.45,27.39, CULTURE-NOSE,87070,HCPCS,300,RC,,,,both,127.04,88.93,,,,,,,,,,,,,,,,,,,Other,27.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.45,27.39, BASIC MET PANEL,80048,HCPCS,301,RC,,,,both,131.88,92.32,,,,,,,,,,,,,,,,,,,Other,28.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.29,28.43, COMP MET PANEL,80053,HCPCS,301,RC,,,,both,250.4,175.28,,,,,,,,,,,,,,,,,,,Other,53.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.35,53.99, IM. ASSAY NOT INFECTIOUS AG OR AB,83516,HCPCS,300,RC,,,,both,65.78,46.05,,,,,,,,,,,,,,,,,,,Other,14.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.3,14.18, RNA POLYMERASE III IGG,83520,HCPCS,301,RC,,,,both,151.9,106.33,,,,,,,,,,,,,,,,,,,Other,32.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.92,32.75, GLUTAMIC ACID DECARBOXYIASE AB,83516,HCPCS,300,RC,,,,both,91.63,64.14,,,,,,,,,,,,,,,,,,,Other,19.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.3,19.76, HISTONE AB,83516,HCPCS,301,RC,,,,both,70.9,49.63,,,,,,,,,,,,,,,,,,,Other,15.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.3,15.29, COPEPTIN PROAVP,84588,HCPCS,301,RC,,,,both,304,212.8,,,,,,,,,,,,,,,,,,,Other,65.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,33.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,33.26,65.54, BLOOD DRAW - CAPILLARY,36416,HCPCS,300,RC,,,,both,18.41,12.89,,,,,,,,,,,,,,,,,,,Other,3.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.97,3.97, BLOOD DRAWING,36415,HCPCS,300,RC,,,,both,17.89,12.52,,,,,,,,,,,,,,,,,,,Other,3.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.86,9.15, COLLECTION FEE,72,RC,,,,,,both,31.97,22.38,,,,,,,,,,,,,,,,,,,Other,6.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.89,6.89, BLOOD TYPING PHENOTYPE SEROLOGIC,86906,HCPCS,305,RC,,,,both,229.78,160.85,,,,,,,,,,,,,,,,,,,Other,49.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.6,49.54, CK-MB,82553,HCPCS,301,RC,,,,both,148.58,104.01,,,,,,,,,,,,,,,,,,,Other,32.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.32,32.04, CK ISOENZYMES,82552,HCPCS,301,RC,,,,both,79.75,55.83,,,,,,,,,,,,,,,,,,,Other,17.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.12,17.2, MYCOPLASMA PN IgG,86738,HCPCS,300,RC,,,,both,56.69,39.68,,,,,,,,,,,,,,,,,,,Other,12.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.22,12.98, MYOGLOBIN-SERUM,83874,HCPCS,301,RC,,,,both,162.2,113.54,,,,,,,,,,,,,,,,,,,Other,34.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.66,34.97, PHLEBOTOMY THERAPEUTIC,99195,HCPCS,940,RC,,,,both,346.27,242.39,,,,,,,,,,,,,,,,,,,Other,74.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,88.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,74.66,88.93, RED CELL SEPERATION AB SCREEN,390,RC,,,,,,both,222.71,155.9,,,,,,,,,,,,,,,,,,,Other,48.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,48.02,48.02, EBV QUANT PCR,87799,HCPCS,306,RC,,,,both,322.78,225.95,,,,,,,,,,,,,,,,,,,Other,69.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,41.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,41.98,69.59, EBV ABS-EA,86663,HCPCS,300,RC,,,,both,55.49,38.84,,,,,,,,,,,,,,,,,,,Other,11.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.97,12.86, WEST NILE VIRUS ABS,86789,HCPCS,300,RC,,,,both,200,140,,,,,,,,,,,,,,,,,,,Other,43.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.1,43.12, HTLV I/II ANTIBODIES,86790,HCPCS,300,RC,,,,both,42.08,29.46,,,,,,,,,,,,,,,,,,,Other,9.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.07,12.62, UROVYSION,88120,HCPCS,300,RC,,,,both,1155,808.5,,,,,,,,,,,,,,,,,,,Other,489.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,489.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,489.43,489.43, BETA 2 GLYCOPROT IGA,86146,HCPCS,300,RC,,,,both,381.75,267.23,,,,,,,,,,,,,,,,,,,Other,82.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.94,82.31, BETA 2 GLYCOPROT IGG,86146,HCPCS,300,RC,,,,both,381.75,267.23,,,,,,,,,,,,,,,,,,,Other,82.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.94,82.31, BETA 2 GLYCOPROT IGM,86146,HCPCS,300,RC,,,,both,381.75,267.23,,,,,,,,,,,,,,,,,,,Other,82.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.94,82.31, CROSSMATCH UNIT 2,86920,HCPCS,300,RC,,,,both,391.24,273.87,,,,,,,,,,,,,,,,,,,Other,84.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,84.35,84.35, CROSSMATCH,86920,HCPCS,300,RC,,,,both,376.19,263.33,,,,,,,,,,,,,,,,,,,Other,81.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.1,81.1, BLD TYPG RH ONLY,86901,HCPCS,300,RC,,,,both,108.26,75.78,,,,,,,,,,,,,,,,,,,Other,23.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.93,23.34, ANTIBODY SCREEN,86850,HCPCS,300,RC,,,,both,188.5,131.95,,,,,,,,,,,,,,,,,,,Other,40.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.57,40.64, RBC ENZYME TREATMENT,86971,HCPCS,300,RC,,,,both,151.9,106.33,,,,,,,,,,,,,,,,,,,Other,32.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.75,32.75, PLATELET CROSSMATCH MACE 1,86805,HCPCS,300,RC,,,,both,254.44,178.11,,,,,,,,,,,,,,,,,,,Other,54.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,185.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,54.86,185.72, PLATELET CROSSMATCH MACE 2,86922,HCPCS,300,RC,,,,both,384.25,268.98,,,,,,,,,,,,,,,,,,,Other,82.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,82.85,82.85, DIRECT COOMBS TEST,86880,HCPCS,300,RC,,,,both,113.92,79.74,,,,,,,,,,,,,,,,,,,Other,24.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.28,24.56, ALDOSTERNE URINE,82088,HCPCS,301,RC,,,,both,142.26,99.58,,,,,,,,,,,,,,,,,,,Other,30.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,39.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.67,39.94, ALKALINE PHOSPHATASE,84075,HCPCS,301,RC,,,,both,50.24,35.17,,,,,,,,,,,,,,,,,,,Other,10.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.08,10.83, ALK PHOS ISOS,84080,HCPCS,301,RC,,,,both,130.43,91.3,,,,,,,,,,,,,,,,,,,Other,28.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.48,28.12, 21 HYDROXYLASE ANTIBODIES,83516,HCPCS,306,RC,,,,both,181.5,127.05,,,,,,,,,,,,,,,,,,,Other,39.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.3,39.13, INTRINSIC FACTOR BLOCK ANTIBODY,86340,HCPCS,306,RC,,,,both,140.08,98.06,,,,,,,,,,,,,,,,,,,Other,30.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.78,30.2, ARTERIAL BLD GAS EPOC,82803,HCPCS,301,RC,,,,both,256.28,179.4,,,,,,,,,,,,,,,,,,,Other,55.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,25.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,25.55,55.25, VENOUS BLD GAS EPOC,82803,HCPCS,301,RC,,,,both,361,252.7,,,,,,,,,,,,,,,,,,,Other,77.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,25.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,25.55,77.83, TB IDENTIFICATION,87149,HCPCS,300,RC,,,,both,133.8,93.66,,,,,,,,,,,,,,,,,,,Other,28.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.65,28.85, BACTERIAL ID 1,87077,HCPCS,300,RC,,,,both,73.61,51.53,,,,,,,,,,,,,,,,,,,Other,15.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.92,15.87, REF BACTERIAL ID(MULTI-STEP),87077,HCPCS,300,RC,,,,both,136.33,95.43,,,,,,,,,,,,,,,,,,,Other,29.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.92,29.39, BACTERIAL ID 2,87077,HCPCS,300,RC,,,,both,73.61,51.53,,,,,,,,,,,,,,,,,,,Other,15.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.92,15.87, ANAEROBIC BACT ID,87076,HCPCS,306,RC,,,,both,22,15.4,,,,,,,,,,,,,,,,,,,Other,4.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.74,7.92, PARIETAL CELL AB IGG,83516,HCPCS,306,RC,,,,both,190,133,,,,,,,,,,,,,,,,,,,Other,40.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.3,40.96, CULTURE-FUNGUS,87102,HCPCS,300,RC,,,,both,57.25,40.08,,,,,,,,,,,,,,,,,,,Other,12.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.24,12.35, FUNGUS MOLD ID,87107,HCPCS,306,RC,,,,both,148.93,104.25,,,,,,,,,,,,,,,,,,,Other,32.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.11,32.1, FUNGUS ID PANEL,87107,HCPCS,306,RC,,,,both,218.38,152.87,,,,,,,,,,,,,,,,,,,Other,47.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.11,47.08, ID DNA/RNA SEQUENCING,87153,HCPCS,306,RC,,,,both,439.97,307.98,,,,,,,,,,,,,,,,,,,Other,94.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,94.85,113.05, ASPERGUILLUS AB TITER,86606,HCPCS,300,RC,,,,both,119.63,83.74,,,,,,,,,,,,,,,,,,,Other,25.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.75,25.79, 5' NUCLEOTIDASE,83915,HCPCS,300,RC,,,,both,263.42,184.39,,,,,,,,,,,,,,,,,,,Other,56.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.93,56.79, TSH,84443,HCPCS,301,RC,,,,both,192.72,134.9,,,,,,,,,,,,,,,,,,,Other,41.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.46,41.55, THYROID STIMULATING IMMUNOGLOBULIN,84445,HCPCS,301,RC,,,,both,218.81,153.17,,,,,,,,,,,,,,,,,,,Other,47.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,49.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,47.18,49.84, THYROTROPIN REC AB,83520,HCPCS,301,RC,,,,both,99.43,69.6,,,,,,,,,,,,,,,,,,,Other,21.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.92,21.43, CATECHLMNS/FRACT URINE,82384,HCPCS,301,RC,,,,both,129.98,90.99,,,,,,,,,,,,,,,,,,,Other,28.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.74,28.03, CATECHLMNS/PLASMA,82384,HCPCS,301,RC,,,,both,129.98,90.99,,,,,,,,,,,,,,,,,,,Other,28.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.74,28.03, ANA SCREEN,86038,HCPCS,300,RC,,,,both,117.05,81.94,,,,,,,,,,,,,,,,,,,Other,25.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.85,25.24, ANA TITER,86039,HCPCS,300,RC,,,,both,95.76,67.03,,,,,,,,,,,,,,,,,,,Other,20.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.94,20.65, METHEMOGLOBIN QUANT,83050,HCPCS,301,RC,,,,both,21.62,15.13,,,,,,,,,,,,,,,,,,,Other,4.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.66,8.04, ANCA IgG,86255,HCPCS,300,RC,,,,both,164.48,115.14,,,,,,,,,,,,,,,,,,,Other,35.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.47,35.47, ANCA TITER,86256,HCPCS,300,RC,,,,both,66.03,46.22,,,,,,,,,,,,,,,,,,,Other,14.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.24,14.24, METANEPHRINE 24 HR UR,83835,HCPCS,301,RC,,,,both,91.85,64.3,,,,,,,,,,,,,,,,,,,Other,19.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.6,19.81, CHYMOTRYPSIN STOOL,84311,HCPCS,301,RC,,,,both,452.1,316.47,,,,,,,,,,,,,,,,,,,Other,97.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.94,97.47, CMV AB IGG,86644,HCPCS,300,RC,,,,both,92,64.4,,,,,,,,,,,,,,,,,,,Other,19.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.1,19.84, BETA 2 TRANSFERRIN,86335,HCPCS,300,RC,,,,both,410.97,287.68,,,,,,,,,,,,,,,,,,,Other,88.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,88.6,88.6, AB CMV IGM,86645,HCPCS,300,RC,,,,both,91.91,64.34,,,,,,,,,,,,,,,,,,,Other,19.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.51,19.82, CONCENTRATION AFB,87015,HCPCS,306,RC,,,,both,38.84,27.19,,,,,,,,,,,,,,,,,,,Other,8.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.55,8.37, ACID FAST STAIN,87206,HCPCS,306,RC,,,,both,31.26,21.88,,,,,,,,,,,,,,,,,,,Other,6.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.28,6.74, CULTURE-AFB,87116,HCPCS,306,RC,,,,both,247.57,173.3,,,,,,,,,,,,,,,,,,,Other,53.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.58,53.38, "PORPHYRINS, URINE",84120,HCPCS,301,RC,,,,both,109.19,76.43,,,,,,,,,,,,,,,,,,,Other,23.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.42,23.54, PORPHOBILINOGEN URINE,84110,HCPCS,301,RC,,,,both,81.79,57.25,,,,,,,,,,,,,,,,,,,Other,17.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.27,17.63, BK VIRUS PCR PLASMA,87799,HCPCS,301,RC,,,,both,695.27,486.69,,,,,,,,,,,,,,,,,,,Other,149.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,41.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,41.98,149.9, LEFLUNOMODE,80193,HCPCS,301,RC,,,,both,524.64,367.25,,,,,,,,,,,,,,,,,,,Other,113.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,37.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,37.8,113.11, ALPHAFETOPROT MATRNL,82105,HCPCS,301,RC,,,,both,91.85,64.3,,,,,,,,,,,,,,,,,,,Other,19.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.43,19.81, ALDOSTERNE SERUM,82088,HCPCS,301,RC,,,,both,142.26,99.58,,,,,,,,,,,,,,,,,,,Other,30.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,39.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.67,39.94, ALPHA 1 ANTITRYPSIN,82103,HCPCS,301,RC,,,,both,80.05,56.04,,,,,,,,,,,,,,,,,,,Other,17.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.17,17.26, ALPHA 1 ANTITRYPSIN - PHENOTYPE,82104,HCPCS,301,RC,,,,both,190.76,133.53,,,,,,,,,,,,,,,,,,,Other,41.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.17,41.13, STOOL ALPHA 1 ANTITRYPSIN,82103,HCPCS,301,RC,,,,both,80.05,56.04,,,,,,,,,,,,,,,,,,,Other,17.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.17,17.26, ALPHA FETOPROTEIN L3,82107,HCPCS,301,RC,,,,both,277.25,194.08,,,,,,,,,,,,,,,,,,,Other,59.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,59.78,63.12, ALPHA FETOPROT TM,82105,HCPCS,301,RC,,,,both,91.85,64.3,,,,,,,,,,,,,,,,,,,Other,19.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.43,19.81, INTRACONAZOLE,80299,HCPCS,301,RC,,,,both,131.75,92.23,,,,,,,,,,,,,,,,,,,Other,28.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.27,28.41, ARK IMMUNOHISTOCHEMICAL,88342,HCPCS,319,RC,,,,both,385.04,269.53,,,,,,,,,,,,,,,,,,,Other,100.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,100.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,100.98,100.98, ARK IMMUNOHISTOCHEMICAL ADDL,88341,HCPCS,319,RC,,,,both,340.49,238.34,,,,,,,,,,,,,,,,,,,Other,86.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,86.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,86.05,86.05, ARK TISSUE EXAM PATH,88305,HCPCS,319,RC,,,,both,256.73,179.71,,,,,,,,,,,,,,,,,,,Other,65.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,65.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.27,65.27, ARK 88344 GLOBAL,88344,HCPCS,319,RC,,,,both,676.33,473.43,,,,,,,,,,,,,,,,,,,Other,157.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,157.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,157.66,157.66, ARK ENZYME HC FROZEN,88319,HCPCS,319,RC,,,,both,522.65,365.86,,,,,,,,,,,,,,,,,,,Other,120.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,120.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,120.17,120.17, VARICELLA ZOSTER IGG,86787,HCPCS,300,RC,,,,both,42.93,30.05,,,,,,,,,,,,,,,,,,,Other,9.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.25,12.62, VARICELLA ZOSTER IGM,86787,HCPCS,300,RC,,,,both,42.93,30.05,,,,,,,,,,,,,,,,,,,Other,9.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.25,12.62, HERP SIMPLX IGG I AND 2,86695,HCPCS,300,RC,,,,both,80.05,56.04,,,,,,,,,,,,,,,,,,,Other,17.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.93,17.26, HSV 2 GLYCOPROTEIN G AB IGG,86696,HCPCS,300,RC,,,,both,183.13,128.19,,,,,,,,,,,,,,,,,,,Other,39.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.96,39.48, HERPES SIMPLX IGM TYPES 1 AND 2,86694,HCPCS,302,RC,,,,both,132,92.4,,,,,,,,,,,,,,,,,,,Other,28.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.1,28.46, VDRL,86592,HCPCS,300,RC,,,,both,40.02,28.01,,,,,,,,,,,,,,,,,,,Other,8.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.18,8.62, PH VENOUS BLOOD,82800,HCPCS,301,RC,,,,both,59.88,41.92,,,,,,,,,,,,,,,,,,,Other,12.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.78,12.91, PRSTTC ACD PHOS,84066,HCPCS,301,RC,,,,both,75.37,52.76,,,,,,,,,,,,,,,,,,,Other,16.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.47,16.25, ALLOGENIC ADSORPTION,86978,HCPCS,301,RC,,,,both,264,184.8,,,,,,,,,,,,,,,,,,,Other,56.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,56.92,56.92, ELCTRPHRSS URINE PROTEIN,84166,HCPCS,301,RC,,,,both,69.37,48.56,,,,,,,,,,,,,,,,,,,Other,14.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.95,14.95, ELCTRPHRSS-PROTEIN SERU,84165,HCPCS,301,RC,,,,both,105.78,74.05,,,,,,,,,,,,,,,,,,,Other,22.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.8,22.8, FREE LIGHT CHAINS SERUM,83883,HCPCS,301,RC,,,,both,241.02,168.71,,,,,,,,,,,,,,,,,,,Other,51.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.33,51.96, FREE LIGHT CHAINS K/L SERUM,83883,HCPCS,301,RC,,,,both,128.17,89.72,,,,,,,,,,,,,,,,,,,Other,27.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.33,27.64, FREE LITE CHAINS - KAPPA URINE,83883,HCPCS,300,RC,,,,both,128.17,89.72,,,,,,,,,,,,,,,,,,,Other,27.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.33,27.64, FREE LITE CHAINS LAMBDA URINE,83883,HCPCS,300,RC,,,,both,128.17,89.72,,,,,,,,,,,,,,,,,,,Other,27.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.33,27.64, ELECTROPHORESIS URINE RANDOM,84166,HCPCS,301,RC,,,,both,72.14,50.5,,,,,,,,,,,,,,,,,,,Other,15.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.55,15.55, FROZ PROG RECEPTOR,84234,HCPCS,301,RC,,,,both,266.29,186.4,,,,,,,,,,,,,,,,,,,Other,57.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,57.41,63.58, CORTISOL BLOOD (TOTAL),82533,HCPCS,301,RC,,,,both,88.77,62.14,,,,,,,,,,,,,,,,,,,Other,19.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.97,19.14, FREE CORTISOL SERUM,82530,HCPCS,301,RC,,,,both,89.11,62.38,,,,,,,,,,,,,,,,,,,Other,19.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.38,19.21, CORTISOL SALIVA,82533,HCPCS,301,RC,,,,both,204.48,143.14,,,,,,,,,,,,,,,,,,,Other,44.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.97,44.09, CHLAMYDIA BY LCR,87491,HCPCS,300,RC,,,,both,129.13,90.39,,,,,,,,,,,,,,,,,,,Other,27.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.84,34.39, COCCIDIOIDES AB BY CF,86635,HCPCS,300,RC,,,,both,161,112.7,,,,,,,,,,,,,,,,,,,Other,34.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.24,34.71, LIPASE-SERUM,83690,HCPCS,301,RC,,,,both,103.6,72.52,,,,,,,,,,,,,,,,,,,Other,22.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.75,22.33, LIPID PROFILE,80061,HCPCS,301,RC,,,,both,184.98,129.49,,,,,,,,,,,,,,,,,,,Other,39.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.12,39.89, GENERAL HEALTH PANEL,80050,HCPCS,301,RC,,,,both,399.04,279.33,,,,,,,,,,,,,,,,,,,Other,86.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,86.03,86.03, LITHIUM,80178,HCPCS,301,RC,,,,both,85.37,59.76,,,,,,,,,,,,,,,,,,,Other,18.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.48,18.4, MERCURY QUANTITATIVE,83825,HCPCS,301,RC,,,,both,105.04,73.53,,,,,,,,,,,,,,,,,,,Other,22.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.93,22.65, IODINE SPOT URINE,83789,HCPCS,301,RC,,,,both,146.06,102.24,,,,,,,,,,,,,,,,,,,Other,31.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.63,31.49, GLYCOHEMOGLOBIN,83036,HCPCS,301,RC,,,,both,126.84,88.79,,,,,,,,,,,,,,,,,,,Other,27.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.52,27.34, HUMAN GROWTH HORMONE,83003,HCPCS,301,RC,,,,both,88.77,62.14,,,,,,,,,,,,,,,,,,,Other,19.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.34,19.14, FOLIC ACID,82746,HCPCS,301,RC,,,,both,88.51,61.96,,,,,,,,,,,,,,,,,,,Other,19.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.41,19.08, T3 REVERSE,84482,HCPCS,301,RC,,,,both,74.78,52.35,,,,,,,,,,,,,,,,,,,Other,16.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.44,16.12, T3 (TRIIODOTHYRONINE),84480,HCPCS,301,RC,,,,both,118.3,82.81,,,,,,,,,,,,,,,,,,,Other,25.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.9,25.51, HISTOPLASMA AB (ID),86698,HCPCS,300,RC,,,,both,58.14,40.7,,,,,,,,,,,,,,,,,,,Other,12.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.53,13.51, HISTOPLASMA AG URINE,87385,HCPCS,300,RC,,,,both,186.96,130.87,,,,,,,,,,,,,,,,,,,Other,40.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.98,40.31, HISTOPLASMA AG SERUM,87385,HCPCS,300,RC,,,,both,186.96,130.87,,,,,,,,,,,,,,,,,,,Other,40.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.98,40.31, THYROID PEROXIDASE AB,86376,HCPCS,300,RC,,,,both,98.04,68.63,,,,,,,,,,,,,,,,,,,Other,21.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.26,21.14, MICROSOME LIV/KID AB,86376,HCPCS,300,RC,,,,both,81.91,57.34,,,,,,,,,,,,,,,,,,,Other,17.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.26,17.66, GENTAMYCIN RANDOM,80170,HCPCS,301,RC,,,,both,121.52,85.06,,,,,,,,,,,,,,,,,,,Other,26.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.05,26.2, GENTAMYCIN THROUGH,80170,HCPCS,301,RC,,,,both,183.75,128.63,,,,,,,,,,,,,,,,,,,Other,39.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.05,39.62, GENTAMYCIN PEAK,80170,HCPCS,301,RC,,,,both,121.52,85.06,,,,,,,,,,,,,,,,,,,Other,26.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.05,26.2, LEPTIN,83520,HCPCS,300,RC,,,,both,160.67,112.47,,,,,,,,,,,,,,,,,,,Other,34.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.92,34.64, INFLUENZA A AB IgG,86710,HCPCS,300,RC,,,,both,125.9,88.13,,,,,,,,,,,,,,,,,,,Other,27.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.28,27.15, TRYPTASE,83520,HCPCS,300,RC,,,,both,80.98,56.69,,,,,,,,,,,,,,,,,,,Other,17.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.92,17.46, INSULIN SERUM,83525,HCPCS,300,RC,,,,both,102.79,71.95,,,,,,,,,,,,,,,,,,,Other,22.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.2,22.16, FREE INSULIN (TOTAL ),83527,HCPCS,301,RC,,,,both,52,36.4,,,,,,,,,,,,,,,,,,,Other,11.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.21,12.69, FREE PLASMA METANEPHRINES,83835,HCPCS,301,RC,,,,both,311.5,218.05,,,,,,,,,,,,,,,,,,,Other,67.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.6,67.16, INTRINSIC FACTOR,86340,HCPCS,302,RC,,,,both,87.92,61.54,,,,,,,,,,,,,,,,,,,Other,18.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.78,18.95, HOMOVANILLIC ACID,83150,HCPCS,300,RC,,,,both,91,63.7,,,,,,,,,,,,,,,,,,,Other,19.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,21.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.62,21.96, ACETYCHOLINE RECEPTOR BINDING AB,83519,HCPCS,300,RC,,,,both,248.16,173.71,,,,,,,,,,,,,,,,,,,Other,53.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.03,53.51, ACETYCHOLINE RECEPTOR BLOCKING AB,83519,HCPCS,300,RC,,,,both,111.81,78.27,,,,,,,,,,,,,,,,,,,Other,24.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.03,24.11, MANNOSE BINDING LECTIN,83520,HCPCS,300,RC,,,,both,195.12,136.58,,,,,,,,,,,,,,,,,,,Other,42.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.92,42.07, VOLTAGE GATED CALCIUM CHANNEL,83519,HCPCS,300,RC,,,,both,249.96,174.97,,,,,,,,,,,,,,,,,,,Other,53.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.03,53.89, ACETYCHOLINE REC MODULATING AB,83519,HCPCS,300,RC,,,,both,222.01,155.41,,,,,,,,,,,,,,,,,,,Other,47.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.03,47.86, ANTI MULLERIAN HORMONE,83520,HCPCS,300,RC,,,,both,229.07,160.35,,,,,,,,,,,,,,,,,,,Other,49.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.92,49.39, MUSK AUTOANTIBODY,83519,HCPCS,300,RC,,,,both,1974.74,1382.32,,,,,,,,,,,,,,,,,,,Other,425.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.03,425.75, ACHR GANG NEURON AB,83519,HCPCS,300,RC,,,,both,248.16,173.71,,,,,,,,,,,,,,,,,,,Other,53.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.03,53.51, NEURONAL VGKC AUTO AB,83519,HCPCS,300,RC,,,,both,265.82,186.07,,,,,,,,,,,,,,,,,,,Other,57.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.03,57.31, STRIATIONAL AB,83520,HCPCS,301,RC,,,,both,237.52,166.26,,,,,,,,,,,,,,,,,,,Other,51.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.92,51.2, PHENOBARBITOL,80184,HCPCS,301,RC,,,,both,128.17,89.72,,,,,,,,,,,,,,,,,,,Other,27.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.99,27.64, TEGRETOL (CARBAM),80156,HCPCS,301,RC,,,,both,150.85,105.6,,,,,,,,,,,,,,,,,,,Other,32.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.28,32.53, CARBAMAZEPINE FREE,80157,HCPCS,301,RC,,,,both,180.22,126.15,,,,,,,,,,,,,,,,,,,Other,38.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.98,38.86, "DILANTIN, FREE",80186,HCPCS,301,RC,,,,both,109.17,76.42,,,,,,,,,,,,,,,,,,,Other,23.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.48,23.54, DILANTIN,80185,HCPCS,301,RC,,,,both,147.45,103.22,,,,,,,,,,,,,,,,,,,Other,31.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.98,31.79, SIROLIMUS,80195,HCPCS,301,RC,,,,both,158.8,111.16,,,,,,,,,,,,,,,,,,,Other,34.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.46,34.24, TACROLIMUS(FK 506),80197,HCPCS,301,RC,,,,both,242.4,169.68,,,,,,,,,,,,,,,,,,,Other,52.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.46,52.26, TOX SCREEN URINE,80307,HCPCS,301,RC,,,,both,123.86,86.7,,,,,,,,,,,,,,,,,,,Other,26.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,60.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.7,60.9, TOXOPLASMOSIS ABS IgG,86777,HCPCS,300,RC,,,,both,87.98,61.59,,,,,,,,,,,,,,,,,,,Other,18.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.1,18.97, TETANUS AB,86317,HCPCS,300,RC,,,,both,80.05,56.04,,,,,,,,,,,,,,,,,,,Other,17.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.69,17.26, DIPHTHERIA AB,86317,HCPCS,300,RC,,,,both,80.05,56.04,,,,,,,,,,,,,,,,,,,Other,17.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.69,17.26, PNEUMOCOCCAL AB,86317,HCPCS,300,RC,,,,both,9.08,6.36,,,,,,,,,,,,,,,,,,,Other,1.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.96,8.9, 5 HIAA SEROTONIN,83497,HCPCS,301,RC,,,,both,61.35,42.95,,,,,,,,,,,,,,,,,,,Other,13.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.64,13.23, 17 HYDROXYPROGESTERONE,83498,HCPCS,301,RC,,,,both,76.02,53.21,,,,,,,,,,,,,,,,,,,Other,16.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.39,26.63, VMA 24 HR URINE,84585,HCPCS,301,RC,,,,both,126.69,88.68,,,,,,,,,,,,,,,,,,,Other,27.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.19,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.19,27.31, CULTURE - VIRAL,87252,HCPCS,300,RC,,,,both,120.63,84.44,,,,,,,,,,,,,,,,,,,Other,26.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,25.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,25.55,26.01, IRON,83540,HCPCS,300,RC,,,,both,56.09,39.26,,,,,,,,,,,,,,,,,,,Other,12.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.34,12.09, HPV DNA,87624,HCPCS,300,RC,,,,both,178.2,124.74,,,,,,,,,,,,,,,,,,,Other,38.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.39,38.42, ZINC,84630,HCPCS,301,RC,,,,both,69.23,48.46,,,,,,,,,,,,,,,,,,,Other,14.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.16,14.93, ZINC RBC,84630,HCPCS,301,RC,,,,both,334.81,234.37,,,,,,,,,,,,,,,,,,,Other,72.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.16,72.19, CEA,82378,HCPCS,301,RC,,,,both,182.6,127.82,,,,,,,,,,,,,,,,,,,Other,39.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.58,39.37, ESTRIOL,82677,HCPCS,301,RC,,,,both,85,59.5,,,,,,,,,,,,,,,,,,,Other,18.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.33,23.7, ESTRADIOL,82670,HCPCS,301,RC,,,,both,90.18,63.13,,,,,,,,,,,,,,,,,,,Other,19.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.44,27.38, INHIBIN-MATERNAL SERUM,86336,HCPCS,302,RC,,,,both,92.13,64.49,,,,,,,,,,,,,,,,,,,Other,19.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.28,19.86, INHIBIN B,83520,HCPCS,301,RC,,,,both,256.45,179.52,,,,,,,,,,,,,,,,,,,Other,55.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.92,55.29, PROTEIN URINE,84156,HCPCS,301,RC,,,,both,64.26,44.98,,,,,,,,,,,,,,,,,,,Other,13.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.6,13.86, "PROTEIN, CSF",84157,HCPCS,301,RC,,,,both,62.45,43.72,,,,,,,,,,,,,,,,,,,Other,13.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.92,13.47, PROTEIN BODY FLUID,84157,HCPCS,301,RC,,,,both,50.24,35.17,,,,,,,,,,,,,,,,,,,Other,10.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.92,10.83, MICROALBUMIN URINE,82043,HCPCS,301,RC,,,,both,87.64,61.35,,,,,,,,,,,,,,,,,,,Other,18.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.66,18.89, CELL COUNT BODY FL,89050,HCPCS,300,RC,,,,both,97.07,67.95,,,,,,,,,,,,,,,,,,,Other,20.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.63,20.93, CERULOPLASMIN,82390,HCPCS,301,RC,,,,both,94.67,66.27,,,,,,,,,,,,,,,,,,,Other,20.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.53,20.41, IGF BINDING PROTEINS,82397,HCPCS,301,RC,,,,both,51.5,36.05,,,,,,,,,,,,,,,,,,,Other,11.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.1,13.84, VASCULAR ENDOTHELIAL GROWTH FACTOR,82397,HCPCS,301,RC,,,,both,233.71,163.6,,,,,,,,,,,,,,,,,,,Other,50.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.84,50.39, CYCLOSPORINE,80158,HCPCS,300,RC,,,,both,164.48,115.14,,,,,,,,,,,,,,,,,,,Other,35.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.69,35.47, RBC PRETREATMENT DENSITY GRADIENT,86972,HCPCS,300,RC,,,,both,325,227.5,,,,,,,,,,,,,,,,,,,Other,70.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,70.07,70.07, RBC CHEMICAL TREATMENT,86970,HCPCS,300,RC,,,,both,115.86,81.1,,,,,,,,,,,,,,,,,,,Other,24.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.98,24.98, ADSORPTION,86978,HCPCS,300,RC,,,,both,75.82,53.07,,,,,,,,,,,,,,,,,,,Other,16.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.35,16.35, "ELUTION, ANTIBODY",86860,HCPCS,300,RC,,,,both,380.21,266.15,,,,,,,,,,,,,,,,,,,Other,81.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.98,81.98, ANTIBODY ID,86870,HCPCS,300,RC,,,,both,255.6,178.92,,,,,,,,,,,,,,,,,,,Other,55.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,55.11,55.11, B2 GLYCOPROTEIN 1 AB - IGG,86146,HCPCS,302,RC,,,,both,25.45,17.82,,,,,,,,,,,,,,,,,,,Other,5.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.49,24.94, CARDIOLIPIN AB-IgG,86147,HCPCS,300,RC,,,,both,109.54,76.68,,,,,,,,,,,,,,,,,,,Other,23.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.62,24.94, CBC AUTOMATED DIFFERENTIAL,85025,HCPCS,300,RC,,,,both,130,91,,,,,,,,,,,,,,,,,,,Other,28.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.61,28.03, MANUAL DIFFERENTIAL,85007,HCPCS,300,RC,,,,both,23.08,16.16,,,,,,,,,,,,,,,,,,,Other,4.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.72,4.98, HEMOGRAM,85027,HCPCS,300,RC,,,,both,61.35,42.95,,,,,,,,,,,,,,,,,,,Other,13.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.34,13.23, SMITH ANTIBODY IGG,86235,HCPCS,302,RC,,,,both,22.29,15.6,,,,,,,,,,,,,,,,,,,Other,4.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.8,17.57, RNP AB,86235,HCPCS,302,RC,,,,both,25.79,18.05,,,,,,,,,,,,,,,,,,,Other,5.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.56,17.57, FACTOR 7 ASSAY,85230,HCPCS,300,RC,,,,both,152.18,106.53,,,,,,,,,,,,,,,,,,,Other,32.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.54,32.81, SSA ANTIBODIES IGG,86235,HCPCS,302,RC,,,,both,22.29,15.6,,,,,,,,,,,,,,,,,,,Other,4.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.8,17.57, SSB ABS IGG,86235,HCPCS,302,RC,,,,both,22.29,15.6,,,,,,,,,,,,,,,,,,,Other,4.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.8,17.57, "JO-1 ANTIBODY, IGG",86235,HCPCS,302,RC,,,,both,22.52,15.76,,,,,,,,,,,,,,,,,,,Other,4.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.85,17.57, FACT VIII ASSAY,85240,HCPCS,300,RC,,,,both,96.06,67.24,,,,,,,,,,,,,,,,,,,Other,20.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.54,20.71, FACTOR II ASSAY,85210,HCPCS,300,RC,,,,both,92.41,64.69,,,,,,,,,,,,,,,,,,,Other,19.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.72,19.92, CHROMATIN,86235,HCPCS,302,RC,,,,both,24.54,17.18,,,,,,,,,,,,,,,,,,,Other,5.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.29,17.57, SM/RNP AB,86235,HCPCS,302,RC,,,,both,22.29,15.6,,,,,,,,,,,,,,,,,,,Other,4.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.8,17.57, ANTI XA,85130,HCPCS,305,RC,,,,both,251.96,176.37,,,,,,,,,,,,,,,,,,,Other,54.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.65,54.32, FACTOR 5 ASSAY,85220,HCPCS,300,RC,,,,both,152.18,106.53,,,,,,,,,,,,,,,,,,,Other,32.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.3,32.81, INFLUENZA B ANTIBODY IGG,86710,HCPCS,300,RC,,,,both,76.81,53.77,,,,,,,,,,,,,,,,,,,Other,16.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.28,16.56, T4 FREE,84439,HCPCS,301,RC,,,,both,130.29,91.2,,,,,,,,,,,,,,,,,,,Other,28.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.84,28.09, DIALYSIS FREE T4,84439,HCPCS,301,RC,,,,both,94.94,66.46,,,,,,,,,,,,,,,,,,,Other,20.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.84,20.47, DIGOXIN,80162,HCPCS,301,RC,,,,both,140.65,98.46,,,,,,,,,,,,,,,,,,,Other,30.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.01,30.32, STOOL PH,83986,HCPCS,300,RC,,,,both,21.62,15.13,,,,,,,,,,,,,,,,,,,Other,4.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.51,4.66, CALPROTECTIN FECAL,83993,HCPCS,300,RC,,,,both,589.86,412.9,,,,,,,,,,,,,,,,,,,Other,127.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.24,127.17, THEOPHYLLINE,80198,HCPCS,301,RC,,,,both,145.89,102.12,,,,,,,,,,,,,,,,,,,Other,31.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.86,31.46, THIAMINE (VIT B1),84425,HCPCS,301,RC,,,,both,158.8,111.16,,,,,,,,,,,,,,,,,,,Other,34.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.81,34.24, NIACIN,84591,HCPCS,301,RC,,,,both,310.37,217.26,,,,,,,,,,,,,,,,,,,Other,66.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.72,66.91, URINALYSIS/MICROSCOPIC CS IF INDICATED,81001,HCPCS,300,RC,,,,both,94,65.8,,,,,,,,,,,,,,,,,,,Other,20.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.11,20.27, BLOOD TYPING ABO ONLY,86900,HCPCS,300,RC,,,,both,204.27,142.99,,,,,,,,,,,,,,,,,,,Other,44.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.93,44.04, NEIS GONOR BY LCR,87591,HCPCS,300,RC,,,,both,129.13,90.39,,,,,,,,,,,,,,,,,,,Other,27.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.84,34.39, MYCOPLASMA PNEUMO PCR,87581,HCPCS,306,RC,,,,both,107.81,75.47,,,,,,,,,,,,,,,,,,,Other,23.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.25,34.39, HERPES VIRUS6 PCR,87532,HCPCS,306,RC,,,,both,260.68,182.48,,,,,,,,,,,,,,,,,,,Other,56.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.39,56.2, M TUBERCULOSIS PCR,87556,HCPCS,306,RC,,,,both,519.08,363.36,,,,,,,,,,,,,,,,,,,Other,111.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,40.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,40.85,111.92, TRIGLYCERIDES,84478,HCPCS,301,RC,,,,both,60.11,42.08,,,,,,,,,,,,,,,,,,,Other,12.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.63,12.96, WESTERN BLOT,86689,HCPCS,300,RC,,,,both,173.8,121.66,,,,,,,,,,,,,,,,,,,Other,37.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.96,37.48, TROPONIN,84484,HCPCS,301,RC,,,,both,179.2,125.44,,,,,,,,,,,,,,,,,,,Other,38.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.22,38.63, TOX-DAV5 NONDOT,80307,HCPCS,301,RC,,,,both,144.88,101.42,,,,,,,,,,,,,,,,,,,Other,31.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,60.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.23,60.9, TOX DAU DOT,80307,HCPCS,301,RC,,,,both,144.88,101.42,,,,,,,,,,,,,,,,,,,Other,31.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,60.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.23,60.9, HMC NEW EMPLOYEE DRUG SCREEN,80307,HCPCS,301,RC,,,,both,13.75,9.63,,,,,,,,,,,,,,,,,,,Other,2.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.97,13.48, TOX-DAU 7,80307,HCPCS,301,RC,,,,both,84.42,59.09,,,,,,,,,,,,,,,,,,,Other,18.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,60.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.2,60.9, WET MOUNT/KOH PREP,87210,HCPCS,300,RC,,,,both,54.03,37.82,,,,,,,,,,,,,,,,,,,Other,11.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.7,11.65, T4 TOTAL,84436,HCPCS,301,RC,,,,both,87.92,61.54,,,,,,,,,,,,,,,,,,,Other,18.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.73,18.95, FERRITIN,82728,HCPCS,301,RC,,,,both,133.84,93.69,,,,,,,,,,,,,,,,,,,Other,28.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.36,28.85, PSA SCREENING,84153,HCPCS,301,RC,,,,both,151.32,105.92,,,,,,,,,,,,,,,,,,,Other,32.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.02,32.62, FREE AND TOTAL PSA,84154,HCPCS,301,RC,,,,both,130.43,91.3,,,,,,,,,,,,,,,,,,,Other,28.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.02,28.12, PRO 2 PSA,86316,HCPCS,302,RC,,,,both,131.74,92.22,,,,,,,,,,,,,,,,,,,Other,28.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.39,28.4, GLUCAGON,82943,HCPCS,301,RC,,,,both,109.26,76.48,,,,,,,,,,,,,,,,,,,Other,23.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14,23.56, ALDOLASE,82085,HCPCS,301,RC,,,,both,61.35,42.95,,,,,,,,,,,,,,,,,,,Other,13.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.52,13.23, AMMONIA,82140,HCPCS,301,RC,,,,both,84.42,59.09,,,,,,,,,,,,,,,,,,,Other,18.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.28,18.2, ELISA,86701,HCPCS,300,RC,,,,both,70.7,49.49,,,,,,,,,,,,,,,,,,,Other,15.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.71,15.24, HIV 1/2 AB,86703,HCPCS,300,RC,,,,both,150,105,,,,,,,,,,,,,,,,,,,Other,32.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.44,32.34, HIV 1/2 ANTIGEN ANTIBODY,87389,HCPCS,306,RC,,,,both,124.56,87.19,,,,,,,,,,,,,,,,,,,Other,26.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.6,26.85, HLAB27,81373,HCPCS,310,RC,,,,both,116.71,81.7,,,,,,,,,,,,,,,,,,,Other,25.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,114.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,25.17,114.38, HOMOCYSTEINE,83090,HCPCS,301,RC,,,,both,170.13,119.09,,,,,,,,,,,,,,,,,,,Other,36.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.56,36.68, PROTOPORPHYRINS FRACT WB,82542,HCPCS,301,RC,,,,both,326.25,228.38,,,,,,,,,,,,,,,,,,,Other,70.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.61,70.34, FSH,83001,HCPCS,301,RC,,,,both,145.18,101.63,,,,,,,,,,,,,,,,,,,Other,31.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.21,31.3, CULTURE-E COLI 0157,87046,HCPCS,300,RC,,,,both,65.78,46.05,,,,,,,,,,,,,,,,,,,Other,14.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.25,14.18, CONCENTRATION STEC,87015,HCPCS,306,RC,,,,both,23.67,16.57,,,,,,,,,,,,,,,,,,,Other,5.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.11,6.55, SHIGA TOXIN 1,87427,HCPCS,306,RC,,,,both,76.16,53.31,,,,,,,,,,,,,,,,,,,Other,16.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.74,16.42, SHIGA TOXIN 2,87427,HCPCS,306,RC,,,,both,76.16,53.31,,,,,,,,,,,,,,,,,,,Other,16.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.74,16.42, CULTURE-SALMONELLA/SHIGELLA,87045,HCPCS,300,RC,,,,both,119.1,83.37,,,,,,,,,,,,,,,,,,,Other,25.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.25,25.68, ELCTRPHRSS HGB,83020,HCPCS,301,RC,,,,both,196.91,137.84,,,,,,,,,,,,,,,,,,,Other,42.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.45,42.45, LEGIONELLA AB SCREEN,86713,HCPCS,300,RC,,,,both,98.88,69.22,,,,,,,,,,,,,,,,,,,Other,21.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.99,21.32, LEGIONELLA PCR,87801,HCPCS,300,RC,,,,both,328.72,230.1,,,,,,,,,,,,,,,,,,,Other,70.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,68.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,68.8,70.87, CT/GC AMPLIFIED DETECTION,87801,HCPCS,300,RC,,,,both,118.3,82.81,,,,,,,,,,,,,,,,,,,Other,25.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,68.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,25.51,68.8, B PERTUSSIS PCR,87801,HCPCS,300,RC,,,,both,274.83,192.38,,,,,,,,,,,,,,,,,,,Other,59.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,68.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,59.25,68.8, CULTURE CHLAMYDIA,87110,HCPCS,300,RC,,,,both,127.63,89.34,,,,,,,,,,,,,,,,,,,Other,27.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.21,27.52, INFLUENZA A/B ANTIGEN,87804,HCPCS,300,RC,,,,both,116.84,81.79,,,,,,,,,,,,,,,,,,,Other,25.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.22,25.19, CAMPYLOBACTER ANTIGEN,87899,HCPCS,300,RC,,,,both,87.9,61.53,,,,,,,,,,,,,,,,,,,Other,18.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.75,18.95, CITRATE URINE,82507,HCPCS,301,RC,,,,both,116.84,81.79,,,,,,,,,,,,,,,,,,,Other,25.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,25.19,27.24, FREE TESTOSTERONE-FEMALE,84402,HCPCS,301,RC,,,,both,102.25,71.58,,,,,,,,,,,,,,,,,,,Other,22.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,22.05,24.96, TESTOSTERONE TOTAL,84403,HCPCS,301,RC,,,,both,234.5,164.15,,,,,,,,,,,,,,,,,,,Other,50.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,25.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,25.29,50.56, SEX HORMONE BINDING GLOBULIN,84270,HCPCS,301,RC,,,,both,85.6,59.92,,,,,,,,,,,,,,,,,,,Other,18.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,21.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.45,21.3, SEMEN POST VAS,89321,HCPCS,300,RC,,,,both,62.32,43.62,,,,,,,,,,,,,,,,,,,Other,13.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.81,13.44, LEUTENIZ HRMN(LH),83002,HCPCS,301,RC,,,,both,226.9,158.83,,,,,,,,,,,,,,,,,,,Other,48.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.15,48.92, VANCOMYCIN TROUGH,80202,HCPCS,301,RC,,,,both,309.19,216.43,,,,,,,,,,,,,,,,,,,Other,66.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.27,66.66, VANCOMYCIN PEAK,80202,HCPCS,301,RC,,,,both,234.79,164.35,,,,,,,,,,,,,,,,,,,Other,50.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.27,50.62, VASO INTESTNL POLYPEPTD,84586,HCPCS,301,RC,,,,both,209.84,146.89,,,,,,,,,,,,,,,,,,,Other,45.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.62,45.24, BHCG-QUANT,84702,HCPCS,301,RC,,,,both,87.92,61.54,,,,,,,,,,,,,,,,,,,Other,18.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.75,18.95, BHCG TUMOR MARKER,84702,HCPCS,301,RC,,,,both,87.92,61.54,,,,,,,,,,,,,,,,,,,Other,18.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.75,18.95, ALCOHOL ETOH,82077,HCPCS,301,RC,,,,both,88.77,62.14,,,,,,,,,,,,,,,,,,,Other,19.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.92,19.14, LEAD LEVEL,83655,HCPCS,301,RC,,,,both,79.39,55.57,,,,,,,,,,,,,,,,,,,Other,17.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.87,17.12, HAPTOGLOBIN,83010,HCPCS,301,RC,,,,both,82.95,58.07,,,,,,,,,,,,,,,,,,,Other,17.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.33,17.88, CULTURE-BODY FLUID,87070,HCPCS,300,RC,,,,both,127.04,88.93,,,,,,,,,,,,,,,,,,,Other,27.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.45,27.39, CULTURE-CAMPYLOBACTR,87046,HCPCS,300,RC,,,,both,92.71,64.9,,,,,,,,,,,,,,,,,,,Other,19.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.25,19.99, AMITRIPTYLINE LEVL,80335,HCPCS,301,RC,,,,both,93.54,65.48,,,,,,,,,,,,,,,,,,,Other,20.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.9,20.17, NORTRIPTYLINE,80335,HCPCS,301,RC,,,,both,63.29,44.3,,,,,,,,,,,,,,,,,,,Other,13.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.9,13.64, HEP C AB,86803,HCPCS,300,RC,,,,both,90.84,63.59,,,,,,,,,,,,,,,,,,,Other,19.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.98,19.58, HEP C GENOTYPE,87902,HCPCS,300,RC,,,,both,517.05,361.94,,,,,,,,,,,,,,,,,,,Other,111.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,252.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,111.48,252.3, HEP A IGG,86708,HCPCS,302,RC,,,,both,75.95,53.17,,,,,,,,,,,,,,,,,,,Other,16.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.14,16.38, HEP A IGM,86709,HCPCS,302,RC,,,,both,41.28,28.9,,,,,,,,,,,,,,,,,,,Other,8.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.9,11.03, HEP B CORE AB TOTAL,86704,HCPCS,300,RC,,,,both,87.92,61.54,,,,,,,,,,,,,,,,,,,Other,18.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.81,18.95, HEPATITIS B CORE AB - IGM,86705,HCPCS,300,RC,,,,both,107.14,75,,,,,,,,,,,,,,,,,,,Other,23.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.53,23.1, PTH-PARTHYRD HRMN,83970,HCPCS,301,RC,,,,both,346.19,242.33,,,,,,,,,,,,,,,,,,,Other,74.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,40.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,40.45,74.64, HEPARIN IND PLTLT AB,86022,HCPCS,300,RC,,,,both,257.25,180.08,,,,,,,,,,,,,,,,,,,Other,55.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18,55.47, IMMUNOGLOBULIN G,82784,HCPCS,301,RC,,,,both,64.55,45.19,,,,,,,,,,,,,,,,,,,Other,13.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.11,13.92, IGG SUBCLASS 1,82787,HCPCS,301,RC,,,,both,41.75,29.23,,,,,,,,,,,,,,,,,,,Other,9.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.86,9.01, IGG SUBCLASS 2,82787,HCPCS,301,RC,,,,both,41.75,29.23,,,,,,,,,,,,,,,,,,,Other,9.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.86,9.01, IGG SUBCLASS 3,82787,HCPCS,301,RC,,,,both,41.75,29.23,,,,,,,,,,,,,,,,,,,Other,9.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.86,9.01, IGG SUBCLASS 4,82787,HCPCS,301,RC,,,,both,41.75,29.23,,,,,,,,,,,,,,,,,,,Other,9.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.86,9.01, IMMUNOGLOBULIN A,82784,HCPCS,301,RC,,,,both,64.55,45.19,,,,,,,,,,,,,,,,,,,Other,13.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.11,13.92, IMMUNOGLOBULIN D,82784,HCPCS,301,RC,,,,both,91.07,63.75,,,,,,,,,,,,,,,,,,,Other,19.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.11,19.64, ELCTRPHRSS-IMMUNO,86334,HCPCS,300,RC,,,,both,169,118.3,,,,,,,,,,,,,,,,,,,Other,36.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.44,36.44, IMMUNOELPHSIS-NOT BLOOD,86335,HCPCS,300,RC,,,,both,189.4,132.58,,,,,,,,,,,,,,,,,,,Other,40.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.84,40.84, IMMUNOGLOBULIN E,82785,HCPCS,301,RC,,,,both,90.18,63.13,,,,,,,,,,,,,,,,,,,Other,19.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.13,19.44, IMMUNOGLOBULIN M,82784,HCPCS,301,RC,,,,both,64.55,45.19,,,,,,,,,,,,,,,,,,,Other,13.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.11,13.92, ALLERGENS UPPER RESP,82785,HCPCS,301,RC,,,,both,43.86,30.7,,,,,,,,,,,,,,,,,,,Other,9.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.46,16.13, IFE URINE QUALITATIVE,86335,HCPCS,300,RC,,,,both,130.87,91.61,,,,,,,,,,,,,,,,,,,Other,28.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28.21,28.21, ALLERGENS FOOD PROFILE,82785,HCPCS,301,RC,,,,both,43.86,30.7,,,,,,,,,,,,,,,,,,,Other,9.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.46,16.13, ALLERGENS CHILDHOOD MARCH PROFILE,82785,HCPCS,301,RC,,,,both,43.86,30.7,,,,,,,,,,,,,,,,,,,Other,9.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.46,16.13, ROTAVIRUS,87425,HCPCS,300,RC,,,,both,88.77,62.14,,,,,,,,,,,,,,,,,,,Other,19.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.74,19.14, H PYLORI ANTIBODY,86677,HCPCS,300,RC,,,,both,119.19,83.43,,,,,,,,,,,,,,,,,,,Other,25.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.51,25.7, H PYLORI AG FECES,87338,HCPCS,300,RC,,,,both,189.63,132.74,,,,,,,,,,,,,,,,,,,Other,40.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.09,40.89, H PYLORI IGM,86677,HCPCS,300,RC,,,,both,411.96,288.37,,,,,,,,,,,,,,,,,,,Other,88.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.51,88.82, CALCITONIN,82308,HCPCS,301,RC,,,,both,257,179.9,,,,,,,,,,,,,,,,,,,Other,55.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.25,55.41, CA 27-29,86300,HCPCS,300,RC,,,,both,169,118.3,,,,,,,,,,,,,,,,,,,Other,36.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.39,36.44, CA-125,86304,HCPCS,300,RC,,,,both,172.52,120.76,,,,,,,,,,,,,,,,,,,Other,37.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.39,37.19, CA-15-3,86300,HCPCS,300,RC,,,,both,169,118.3,,,,,,,,,,,,,,,,,,,Other,36.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.39,36.44, DS DNA,86225,HCPCS,302,RC,,,,both,18.99,13.29,,,,,,,,,,,,,,,,,,,Other,4.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.1,13.47, PROGESTERONE,84144,HCPCS,301,RC,,,,both,138.38,96.87,,,,,,,,,,,,,,,,,,,Other,29.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.44,29.83, CARBON MONOXIDE,82375,HCPCS,301,RC,,,,both,27.76,19.43,,,,,,,,,,,,,,,,,,,Other,5.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.99,12.07, C-REACTIVE PROTEIN HS,86141,HCPCS,300,RC,,,,both,115.85,81.1,,,,,,,,,,,,,,,,,,,Other,24.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.69,24.98, HDL-CHOL DIRECT,83718,HCPCS,301,RC,,,,both,57.58,40.31,,,,,,,,,,,,,,,,,,,Other,12.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.03,12.42, RUBELLA,86762,HCPCS,300,RC,,,,both,37.1,25.97,,,,,,,,,,,,,,,,,,,Other,8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8,14.1, RUBEOLA IGM,86765,HCPCS,300,RC,,,,both,75.37,52.76,,,,,,,,,,,,,,,,,,,Other,16.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.62,16.25, RUBEOLA,86765,HCPCS,300,RC,,,,both,75.37,52.76,,,,,,,,,,,,,,,,,,,Other,16.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.62,16.25, SALICYLATE,80179,HCPCS,301,RC,,,,both,70.7,49.49,,,,,,,,,,,,,,,,,,,Other,15.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.24,18.27, NICOTINE URINE,80323,HCPCS,300,RC,,,,both,108.88,76.22,,,,,,,,,,,,,,,,,,,Other,23.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.94,23.47, NICOTINE SERUM,80323,HCPCS,301,RC,,,,both,132.92,93.04,,,,,,,,,,,,,,,,,,,Other,28.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.94,28.66, NMR LIPO PROIFILE,83704,HCPCS,301,RC,,,,both,189,132.3,,,,,,,,,,,,,,,,,,,Other,40.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,33.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,33.51,40.75, C3 COMPLEMENT,86160,HCPCS,300,RC,,,,both,80.05,56.04,,,,,,,,,,,,,,,,,,,Other,17.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.76,17.26, CYCLIC CITR PEPTIDE AB IGG,86200,HCPCS,300,RC,,,,both,132.62,92.83,,,,,,,,,,,,,,,,,,,Other,28.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.69,28.6, COMPLEMENT COMPONENT 1 FUNCTIONAL,86161,HCPCS,300,RC,,,,both,207.57,145.3,,,,,,,,,,,,,,,,,,,Other,44.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.76,44.76, COMPLEMENT 2,86160,HCPCS,300,RC,,,,both,120.07,84.05,,,,,,,,,,,,,,,,,,,Other,25.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.76,25.89, COMPLEMENT 4,86160,HCPCS,300,RC,,,,both,82.95,58.07,,,,,,,,,,,,,,,,,,,Other,17.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.76,17.88, C1 ESTERASE INHIBITOR FUNCTIONAL,83520,HCPCS,301,RC,,,,both,189.88,132.92,,,,,,,,,,,,,,,,,,,Other,40.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.92,40.93, C1 ESTERASE INHIBITOR LEVEL,83883,HCPCS,301,RC,,,,both,241,168.7,,,,,,,,,,,,,,,,,,,Other,51.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.33,51.96, C1Q COMPLEMENT,86160,HCPCS,302,RC,,,,both,132.92,93.04,,,,,,,,,,,,,,,,,,,Other,28.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.76,28.66, ANTITHROMBIN III,85300,HCPCS,300,RC,,,,both,152,106.4,,,,,,,,,,,,,,,,,,,Other,32.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.61,32.77, ANTITHROMBIN 3 ANTIGEN,85301,HCPCS,305,RC,,,,both,103.37,72.36,,,,,,,,,,,,,,,,,,,Other,22.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.59,22.29, CA-19-9,86301,HCPCS,300,RC,,,,both,161.06,112.74,,,,,,,,,,,,,,,,,,,Other,34.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.39,34.72, HEP B SUR AB,86706,HCPCS,300,RC,,,,both,75.37,52.76,,,,,,,,,,,,,,,,,,,Other,16.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.53,16.25, HEP B SURFACE AB QUANT,86706,HCPCS,300,RC,,,,both,103.19,72.23,,,,,,,,,,,,,,,,,,,Other,22.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.53,22.25, TOBRAMYCIN,80200,HCPCS,301,RC,,,,both,154.25,107.98,,,,,,,,,,,,,,,,,,,Other,33.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.81,33.26, LEGIONELLA ANTIGEN,87449,HCPCS,300,RC,,,,both,102.25,71.58,,,,,,,,,,,,,,,,,,,Other,22.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.74,22.05, BLASTOMYCES ANTIGEN,87449,HCPCS,306,RC,,,,both,398,278.6,,,,,,,,,,,,,,,,,,,Other,85.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.74,85.81, STREP PNEUMO AG,87899,HCPCS,306,RC,,,,both,125.36,87.75,,,,,,,,,,,,,,,,,,,Other,27.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.75,27.03, GASTRIN,82941,HCPCS,301,RC,,,,both,94.67,66.27,,,,,,,,,,,,,,,,,,,Other,20.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.28,20.41, VITAMIN B12,82607,HCPCS,301,RC,,,,both,136.1,95.27,,,,,,,,,,,,,,,,,,,Other,29.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.78,29.34, SYPHILIS IGG,86780,HCPCS,302,RC,,,,both,21.76,15.23,,,,,,,,,,,,,,,,,,,Other,4.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.69,12.98, ASPERGILLUS ANTIGEN,87305,HCPCS,300,RC,,,,both,157.05,109.94,,,,,,,,,,,,,,,,,,,Other,33.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.74,33.86, OXALATE,83945,HCPCS,301,RC,,,,both,75.37,52.76,,,,,,,,,,,,,,,,,,,Other,16.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.16,16.25, LYME DISEASE AB,86618,HCPCS,300,RC,,,,both,118.3,82.81,,,,,,,,,,,,,,,,,,,Other,25.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.69,25.51, LYME DISEASE WESTERN BLOT,86617,HCPCS,300,RC,,,,both,141.98,99.39,,,,,,,,,,,,,,,,,,,Other,30.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.18,30.62, B HENSLAE CAT SCRATCH IGG AND IGM,86611,HCPCS,300,RC,,,,both,146.6,102.62,,,,,,,,,,,,,,,,,,,Other,31.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.98,31.6, BARTONELLA HENSLAE CAT SCRATCH IGM,86611,HCPCS,300,RC,,,,both,146.6,102.62,,,,,,,,,,,,,,,,,,,Other,31.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.98,31.6, B PERTUSSIS IGG,86615,HCPCS,300,RC,,,,both,64.71,45.3,,,,,,,,,,,,,,,,,,,Other,13.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.93,13.96, B PERTUSSIS IGM,86615,HCPCS,300,RC,,,,both,67.3,47.11,,,,,,,,,,,,,,,,,,,Other,14.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.93,14.51, B PERTUSSIS IGA,86615,HCPCS,300,RC,,,,both,67.3,47.11,,,,,,,,,,,,,,,,,,,Other,14.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.93,14.51, HEP B SUR AG,87340,HCPCS,300,RC,,,,both,72.14,50.5,,,,,,,,,,,,,,,,,,,Other,15.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.12,15.55, CONFIRMATION HEP B S AG,87341,HCPCS,300,RC,,,,both,214.53,150.17,,,,,,,,,,,,,,,,,,,Other,46.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.12,46.26, PROTEIN C FUNCTIONAL,85303,HCPCS,300,RC,,,,both,152.18,106.53,,,,,,,,,,,,,,,,,,,Other,32.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.56,32.81, PROTEIN S FUNCTIONAL,85306,HCPCS,300,RC,,,,both,152.18,106.53,,,,,,,,,,,,,,,,,,,Other,32.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.01,32.81, PROLACTIN,84146,HCPCS,301,RC,,,,both,115.68,80.98,,,,,,,,,,,,,,,,,,,Other,24.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.99,24.94, PROCALCITONIN,84145,HCPCS,301,RC,,,,both,365.15,255.61,,,,,,,,,,,,,,,,,,,Other,78.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.68,78.72, 6 MMPN,82542,HCPCS,301,RC,,,,both,139.89,97.92,,,,,,,,,,,,,,,,,,,Other,30.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.61,30.16, 6 TGN,82542,HCPCS,301,RC,,,,both,192.27,134.59,,,,,,,,,,,,,,,,,,,Other,41.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.61,41.45, PROINSULIN,84206,HCPCS,300,RC,,,,both,68.71,48.1,,,,,,,,,,,,,,,,,,,Other,14.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.82,26.16, SEROTONIN,84260,HCPCS,301,RC,,,,both,170.6,119.42,,,,,,,,,,,,,,,,,,,Other,36.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.36,36.78, ZINC PROTOPROPHYRIN,84202,HCPCS,301,RC,,,,both,48.22,33.75,,,,,,,,,,,,,,,,,,,Other,10.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.4,14.06, CALCIUM 24HR URINE,82340,HCPCS,301,RC,,,,both,70.7,49.49,,,,,,,,,,,,,,,,,,,Other,15.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.91,15.24, FREE T3,84481,HCPCS,301,RC,,,,both,120.07,84.05,,,,,,,,,,,,,,,,,,,Other,25.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.6,25.89, CLO-TEST,87077,HCPCS,300,RC,,,,both,94.67,66.27,,,,,,,,,,,,,,,,,,,Other,20.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.92,20.41, H PYLORI DRUG ADMINISTRATION,83014,HCPCS,301,RC,,,,both,26.87,18.81,,,,,,,,,,,,,,,,,,,Other,5.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.79,7.7, H PYLORI BREATH TEST,83013,HCPCS,301,RC,,,,both,148.11,103.68,,,,,,,,,,,,,,,,,,,Other,31.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,66.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.93,66.01, IBD SGI DIAGNOSTIC,81479,HCPCS,310,RC,,,,both,99.01,69.31,,,,,,,,,,,,,,,,,,,Other,21.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,21.34,21.34, C REACTIVE PROTEIN,86140,HCPCS,300,RC,,,,both,116.75,81.73,,,,,,,,,,,,,,,,,,,Other,25.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.08,25.18, PROMETHEUS ASCA IGG,83520,HCPCS,300,RC,,,,both,43.82,30.67,,,,,,,,,,,,,,,,,,,Other,9.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.45,16.92, PROMETHEUS ASCA IGA,83520,HCPCS,300,RC,,,,both,43.82,30.67,,,,,,,,,,,,,,,,,,,Other,9.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.45,16.92, PROMETHEUS IGA,81479,HCPCS,300,RC,,,,both,43.82,30.67,,,,,,,,,,,,,,,,,,,Other,9.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.45,9.45, PROMETHEUS ANTI OMPC IGA,83520,HCPCS,300,RC,,,,both,43.82,30.67,,,,,,,,,,,,,,,,,,,Other,9.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.45,16.92, PROMETHEUS ANTI CBIR1,83520,HCPCS,300,RC,,,,both,43.82,30.67,,,,,,,,,,,,,,,,,,,Other,9.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.45,16.92, PROMETHEUS FLAZ,83520,HCPCS,300,RC,,,,both,35.06,24.54,,,,,,,,,,,,,,,,,,,Other,7.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.56,16.92, PROMETHEUS FLAX,83520,HCPCS,300,RC,,,,both,35.06,24.54,,,,,,,,,,,,,,,,,,,Other,7.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.56,16.92, PROMETHEUS VEGF,82397,HCPCS,300,RC,,,,both,35.06,24.54,,,,,,,,,,,,,,,,,,,Other,7.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.56,13.84, PROMETHEUS ICAM,82397,HCPCS,301,RC,,,,both,35.06,24.54,,,,,,,,,,,,,,,,,,,Other,7.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.56,13.84, PROMETHEUS VCAM,82397,HCPCS,301,RC,,,,both,35.06,24.54,,,,,,,,,,,,,,,,,,,Other,7.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.56,13.84, PROMETHEUS SAA,82397,HCPCS,301,RC,,,,both,35.06,24.54,,,,,,,,,,,,,,,,,,,Other,7.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.56,13.84, PROMETHEUS PANCA,88346,HCPCS,312,RC,,,,both,425.32,297.72,,,,,,,,,,,,,,,,,,,Other,125.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,125.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,125.21,125.21, PROMETHEUS DNASE SENSITIVITY,88350,HCPCS,312,RC,,,,both,408.96,286.27,,,,,,,,,,,,,,,,,,,Other,97.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,97.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,97.71,97.71, ONCOHEME NGS,81450,HCPCS,310,RC,,,,both,6079.85,4255.9,,,,,,,,,,,,,,,,,,,Other,1310.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,744.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,744.34,1310.82, QUAD 1 MARKER,81511,HCPCS,300,RC,,,,both,145.58,101.91,,,,,,,,,,,,,,,,,,,Other,31.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,142.67,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.39,142.67, C-PEPTIDE,84681,HCPCS,301,RC,,,,both,107.86,75.5,,,,,,,,,,,,,,,,,,,Other,23.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.39,23.26, VALPROIC ACID DEPAKENE,80164,HCPCS,301,RC,,,,both,148.29,103.8,,,,,,,,,,,,,,,,,,,Other,31.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.27,31.97, AQUAPORIN-4 IGG,86255,HCPCS,301,RC,,,,both,973.5,681.45,,,,,,,,,,,,,,,,,,,Other,209.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,209.89,209.89, MUELINE OLIGODENDROCYTE GLUCOPROTEIN,86255,HCPCS,301,RC,,,,both,1732.5,1212.75,,,,,,,,,,,,,,,,,,,Other,373.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,373.53,373.53, CSF IGG,82784,HCPCS,301,RC,,,,both,16.13,11.29,,,,,,,,,,,,,,,,,,,Other,3.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.48,9.11, ILIGOCLONAL BANDS CSF,83916,HCPCS,301,RC,,,,both,157.87,110.51,,,,,,,,,,,,,,,,,,,Other,34.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.84,34.04, D-DIMER QUANTITATIVE,85379,HCPCS,300,RC,,,,both,166.16,116.31,,,,,,,,,,,,,,,,,,,Other,35.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.98,35.83, FIBRIN SPLIT PRODUCTS,85362,HCPCS,300,RC,,,,both,41.41,28.99,,,,,,,,,,,,,,,,,,,Other,8.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.75,8.93, CORTISOL - URINE (FREE),82530,HCPCS,301,RC,,,,both,89.11,62.38,,,,,,,,,,,,,,,,,,,Other,19.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.38,19.21, HEP BE AB,86707,HCPCS,300,RC,,,,both,108.04,75.63,,,,,,,,,,,,,,,,,,,Other,23.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.34,23.29, HEP BE AG,87350,HCPCS,300,RC,,,,both,64.55,45.19,,,,,,,,,,,,,,,,,,,Other,13.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.3,13.92, VITAMIN B 6,84207,HCPCS,301,RC,,,,both,144.59,101.21,,,,,,,,,,,,,,,,,,,Other,31.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.54,31.17, MAGNESIUM URINE,83735,HCPCS,301,RC,,,,both,81.67,57.17,,,,,,,,,,,,,,,,,,,Other,17.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.57,17.61, MAGNESIUM SERUM,83735,HCPCS,301,RC,,,,both,81.67,57.17,,,,,,,,,,,,,,,,,,,Other,17.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.57,17.61, MAGNESIUM 24 HR URINE,83735,HCPCS,301,RC,,,,both,36.81,25.77,,,,,,,,,,,,,,,,,,,Other,7.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.57,7.94, MALARIA SMEAR,87207,HCPCS,300,RC,,,,both,42.25,29.58,,,,,,,,,,,,,,,,,,,Other,9.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.11,9.11, ROCKY MTN IGG,86757,HCPCS,300,RC,,,,both,94.67,66.27,,,,,,,,,,,,,,,,,,,Other,20.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.96,20.41, RENAL FAILURE INDICIES 2,84300,HCPCS,301,RC,,,,both,18.5,12.95,,,,,,,,,,,,,,,,,,,Other,3.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.99,4.96, SODIUM URINE,84300,HCPCS,301,RC,,,,both,63.51,44.46,,,,,,,,,,,,,,,,,,,Other,13.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.96,13.69, SODIUM 24 HR URINE,84300,HCPCS,301,RC,,,,both,63.51,44.46,,,,,,,,,,,,,,,,,,,Other,13.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.96,13.69, SOMATOMEDIN C,84305,HCPCS,300,RC,,,,both,105.62,73.93,,,,,,,,,,,,,,,,,,,Other,22.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.83,22.78, URINE PH,81002,HCPCS,300,RC,,,,both,21.8,15.26,,,,,,,,,,,,,,,,,,,Other,4.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.41,4.7, SPECFC GRAV BODY FL,84315,HCPCS,301,RC,,,,both,29.21,20.45,,,,,,,,,,,,,,,,,,,Other,6.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.21,6.3, FACTOR INHIBITOR TEST,85335,HCPCS,300,RC,,,,both,166.62,116.63,,,,,,,,,,,,,,,,,,,Other,35.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.61,35.93, LUPUS INHIBITOR,85300,HCPCS,300,RC,,,,both,152,106.4,,,,,,,,,,,,,,,,,,,Other,32.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.61,32.77, CHLORIDE-URINE,82436,HCPCS,301,RC,,,,both,58.42,40.89,,,,,,,,,,,,,,,,,,,Other,12.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.64,12.59, CHLORIDE 24 HR URINE,82436,HCPCS,301,RC,,,,both,91.38,63.97,,,,,,,,,,,,,,,,,,,Other,19.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.64,19.7, CHLORIDE-SERUM,82435,HCPCS,301,RC,,,,both,35.16,24.61,,,,,,,,,,,,,,,,,,,Other,7.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.51,7.59, CHLORIDE-BODY FLUID,82438,HCPCS,301,RC,,,,both,20.79,14.55,,,,,,,,,,,,,,,,,,,Other,4.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.48,4.9, ANALYZE 20 - 25 CELLS CHROMOSOME,88264,HCPCS,310,RC,,,,both,399.62,279.73,,,,,,,,,,,,,,,,,,,Other,86.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,141.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,86.16,141.72, CELL COUNT/DIF BDYFL,89051,HCPCS,300,RC,,,,both,106.77,74.74,,,,,,,,,,,,,,,,,,,Other,23.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.49,23.02, CRYOPRECIPITATE PER UNIT,P9012,HCPCS,390,RC,,,,both,252.42,176.69,,,,,,,,,,,,,,,,,,,Other,54.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,54.42,54.42, CRYPTOSPORIDIUM AG,87328,HCPCS,300,RC,,,,both,91.44,64.01,,,,,,,,,,,,,,,,,,,Other,19.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.54,19.72, VITAMIN C,82180,HCPCS,301,RC,,,,both,64.55,45.19,,,,,,,,,,,,,,,,,,,Other,13.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.69,13.92, VITAMIN D 25 HYDROXY,82306,HCPCS,301,RC,,,,both,198.48,138.94,,,,,,,,,,,,,,,,,,,Other,42.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,29.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,29.01,42.8, VITAMIN D 125,82652,HCPCS,301,RC,,,,both,96.9,67.83,,,,,,,,,,,,,,,,,,,Other,20.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,37.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.89,37.73, VITAMIN E,84446,HCPCS,300,RC,,,,both,78.28,54.8,,,,,,,,,,,,,,,,,,,Other,16.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.9,16.88, VITAMIN A (RETINOL),84590,HCPCS,300,RC,,,,both,91.18,63.83,,,,,,,,,,,,,,,,,,,Other,19.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.38,19.66, VITAMIN K1,84597,HCPCS,300,RC,,,,both,172.06,120.44,,,,,,,,,,,,,,,,,,,Other,37.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.45,37.09, APOLIPOPROTEIN B,82172,HCPCS,301,RC,,,,both,83.84,58.69,,,,,,,,,,,,,,,,,,,Other,18.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.67,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.07,20.67, 5 A DIHYDROTESTOSTERONE,80327,HCPCS,301,RC,,,,both,110.64,77.45,,,,,,,,,,,,,,,,,,,Other,23.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,21.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,21.74,23.85, VASOPRESSIN ADH,84588,HCPCS,301,RC,,,,both,163.3,114.31,,,,,,,,,,,,,,,,,,,Other,35.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,33.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,33.26,35.21, DIHYDRODAMINE,82657,HCPCS,301,RC,,,,both,667.24,467.07,,,,,,,,,,,,,,,,,,,Other,143.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,21.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,21.73,143.85, LDL-CHOL DIRECT,83721,HCPCS,301,RC,,,,both,59.88,41.92,,,,,,,,,,,,,,,,,,,Other,12.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.29,12.91, ELASTASE STOOL,82656,HCPCS,301,RC,,,,both,262,183.4,,,,,,,,,,,,,,,,,,,Other,56.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.3,56.49, THYROGLOBULIN,84432,HCPCS,301,RC,,,,both,88.77,62.14,,,,,,,,,,,,,,,,,,,Other,19.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.74,19.14, RENAL PANEL,80069,HCPCS,301,RC,,,,both,147,102.9,,,,,,,,,,,,,,,,,,,Other,31.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.51,31.69, APTT CIRCULATING INHIBITOR,85732,HCPCS,300,RC,,,,both,33.01,23.11,,,,,,,,,,,,,,,,,,,Other,7.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.34,7.11, DHEA SULFATE,82627,HCPCS,301,RC,,,,both,120.07,84.05,,,,,,,,,,,,,,,,,,,Other,25.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,21.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,21.79,25.89, DHEA,82626,HCPCS,301,RC,,,,both,53.47,37.43,,,,,,,,,,,,,,,,,,,Other,11.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.52,24.76, BETA HYDROXYBUTYRATE,82010,HCPCS,300,RC,,,,both,101.13,70.79,,,,,,,,,,,,,,,,,,,Other,21.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.01,21.8, CLOZAPINE,80159,HCPCS,301,RC,,,,both,79,55.3,,,,,,,,,,,,,,,,,,,Other,17.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.03,19.75, CALCIUM-IONIZED,82330,HCPCS,301,RC,,,,both,100.27,70.19,,,,,,,,,,,,,,,,,,,Other,21.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.41,21.62, TISSUE TRANSGLUATMINASE IGG,83516,HCPCS,300,RC,,,,both,70.7,49.49,,,,,,,,,,,,,,,,,,,Other,15.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.3,15.24, TISSUE TRANGLUTAMINASE IGA,83516,HCPCS,300,RC,,,,both,70.7,49.49,,,,,,,,,,,,,,,,,,,Other,15.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.3,15.24, "MITOCHONDRIAL AB, IGG",86255,HCPCS,300,RC,,,,both,68.7,48.09,,,,,,,,,,,,,,,,,,,Other,14.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.81,14.81, GLIADIN AB IGA,83516,HCPCS,300,RC,,,,both,70.7,49.49,,,,,,,,,,,,,,,,,,,Other,15.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.3,15.24, GLIADIN AB IGG,83516,HCPCS,300,RC,,,,both,70.7,49.49,,,,,,,,,,,,,,,,,,,Other,15.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.3,15.24, DGP IGA,83516,HCPCS,300,RC,,,,both,72.14,50.5,,,,,,,,,,,,,,,,,,,Other,15.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.3,15.55, RIBOSOME P ANTIBODY IGG,86235,HCPCS,302,RC,,,,both,24.41,17.09,,,,,,,,,,,,,,,,,,,Other,5.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.26,17.57, MYELIN ASSOC GLYCOPROTEIN AB IGM,83516,HCPCS,300,RC,,,,both,82.04,57.43,,,,,,,,,,,,,,,,,,,Other,17.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.3,17.69, CENTROMERE AB,86235,HCPCS,302,RC,,,,both,23.17,16.22,,,,,,,,,,,,,,,,,,,Other,5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5,17.57, ANTIMITOCHONDRIAL ABS,86256,HCPCS,300,RC,,,,both,36.78,25.75,,,,,,,,,,,,,,,,,,,Other,7.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.93,7.93, MYCOPHENOLIC ACID,80180,HCPCS,300,RC,,,,both,100,70,,,,,,,,,,,,,,,,,,,Other,21.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.69,21.56, KEPPRA (LEVETIRACETAM),80177,HCPCS,301,RC,,,,both,156.29,109.4,,,,,,,,,,,,,,,,,,,Other,33.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.98,33.69, TOPIRAMATE (TOPAMAX),80201,HCPCS,301,RC,,,,both,130.87,91.61,,,,,,,,,,,,,,,,,,,Other,28.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.68,28.21, OXCARBAZEPINE (TRILEPTAL),80183,HCPCS,301,RC,,,,both,209,146.3,,,,,,,,,,,,,,,,,,,Other,45.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.98,45.06, LAMOTRIGINE,80175,HCPCS,301,RC,,,,both,78.58,55.01,,,,,,,,,,,,,,,,,,,Other,16.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.98,16.94, LACOSAMIDE (VIMPAT),80339,HCPCS,301,RC,,,,both,491.55,344.09,,,,,,,,,,,,,,,,,,,Other,105.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.9,105.98, CLOBAZAM,80339,HCPCS,301,RC,,,,both,297.95,208.57,,,,,,,,,,,,,,,,,,,Other,64.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.9,64.24, FECAL FAT QUALITATIVE,82705,HCPCS,301,RC,,,,both,50.82,35.57,,,,,,,,,,,,,,,,,,,Other,10.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5,10.96, FECAL FAT (QUANT),82710,HCPCS,301,RC,,,,both,117.44,82.21,,,,,,,,,,,,,,,,,,,Other,25.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.46,25.32, FECAL WBC,89055,HCPCS,300,RC,,,,both,59.62,41.73,,,,,,,,,,,,,,,,,,,Other,12.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.18,12.86, TIBC / TRANSFERRIN,84466,HCPCS,301,RC,,,,both,105.78,74.05,,,,,,,,,,,,,,,,,,,Other,22.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.5,22.8, ACETMNPHEN (TYLENOL),80143,HCPCS,301,RC,,,,both,105.04,73.53,,,,,,,,,,,,,,,,,,,Other,22.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.27,22.65, ACETONE,82009,HCPCS,301,RC,,,,both,31.26,21.88,,,,,,,,,,,,,,,,,,,Other,6.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.43,6.74, ACTH HORMONE,82024,HCPCS,301,RC,,,,both,195.12,136.58,,,,,,,,,,,,,,,,,,,Other,42.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,37.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,37.85,42.07, ACTH STIMULATION,80400,HCPCS,301,RC,,,,both,301.01,210.71,,,,,,,,,,,,,,,,,,,Other,64.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,31.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.97,64.9, RBC FOLATE,82747,HCPCS,301,RC,,,,both,102.25,71.58,,,,,,,,,,,,,,,,,,,Other,22.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.3,22.05, CALCIUM UR QUANT,82340,HCPCS,301,RC,,,,both,20.79,14.55,,,,,,,,,,,,,,,,,,,Other,4.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.48,5.91, GASTRO PATHOGENS,87507,HCPCS,306,RC,,,,both,1116.94,781.86,,,,,,,,,,,,,,,,,,,Other,240.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,408.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,240.82,408.44, ENTEROVIRUS PCR PLASMA,87498,HCPCS,306,RC,,,,both,223.39,156.37,,,,,,,,,,,,,,,,,,,Other,48.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.39,48.17, CMV QUANTITATIVE PCR,87497,HCPCS,306,RC,,,,both,368.07,257.65,,,,,,,,,,,,,,,,,,,Other,79.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,41.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,41.98,79.36, STREP GRP A MOLECULAR,87651,HCPCS,306,RC,,,,both,137.24,96.07,,,,,,,,,,,,,,,,,,,Other,29.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,29.59,34.39, C DIFFICILE TOXIC GENE,87493,HCPCS,306,RC,,,,both,203.03,142.12,,,,,,,,,,,,,,,,,,,Other,43.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.52,43.78, HEPATITIS B VIRAL DNA,87517,HCPCS,306,RC,,,,both,358.14,250.7,,,,,,,,,,,,,,,,,,,Other,77.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,41.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,41.98,77.21, HEPATITIS C RNA PCR QUA,87522,HCPCS,300,RC,,,,both,415.42,290.79,,,,,,,,,,,,,,,,,,,Other,89.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,41.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,41.98,89.56, BK VIRUS URINE,87799,HCPCS,300,RC,,,,both,520.77,364.54,,,,,,,,,,,,,,,,,,,Other,112.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,41.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,41.98,112.28, HERPES SIMPLEX BY PCR,87529,HCPCS,300,RC,,,,both,292.12,204.48,,,,,,,,,,,,,,,,,,,Other,62.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.39,62.98, HEPATITIS PANEL ACUTE,80074,HCPCS,301,RC,,,,both,373.16,261.21,,,,,,,,,,,,,,,,,,,Other,80.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,46.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,46.68,80.46, JC VIRUS,87798,HCPCS,300,RC,,,,both,476.38,333.47,,,,,,,,,,,,,,,,,,,Other,102.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.39,102.7, HEP C RNA QUALITATIVE,87521,HCPCS,306,RC,,,,both,240,168,,,,,,,,,,,,,,,,,,,Other,51.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.39,51.74, B. PERTUSSIS/PARAPERTUSIS PCR,87798,HCPCS,306,RC,,,,both,290.24,203.17,,,,,,,,,,,,,,,,,,,Other,62.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.39,62.57, NOROVIRUS 1 PCR,87798,HCPCS,300,RC,,,,both,354.93,248.45,,,,,,,,,,,,,,,,,,,Other,76.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.39,76.52, NOROVIRUS 2 PCR,87798,HCPCS,300,RC,,,,both,354.93,248.45,,,,,,,,,,,,,,,,,,,Other,76.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.39,76.52, JC POLYOMA VIRUS PCR,87799,HCPCS,306,RC,,,,both,1100.36,770.25,,,,,,,,,,,,,,,,,,,Other,237.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,41.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,41.98,237.24, CANDIDA NA PROBE,87480,HCPCS,306,RC,,,,both,53.49,37.44,,,,,,,,,,,,,,,,,,,Other,11.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.53,19.65, GARDNERELLA PROBE,87510,HCPCS,306,RC,,,,both,53.49,37.44,,,,,,,,,,,,,,,,,,,Other,11.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.53,19.65, TRICH VAG PROBE,87660,HCPCS,306,RC,,,,both,53.49,37.44,,,,,,,,,,,,,,,,,,,Other,11.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.53,19.65, HSV PCR NON CSF,87529,HCPCS,300,RC,,,,both,201.66,141.16,,,,,,,,,,,,,,,,,,,Other,43.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.39,43.48, HSV PCR NON CSF CHARGE ONLY,87529,HCPCS,300,RC,,,,both,202.83,141.98,,,,,,,,,,,,,,,,,,,Other,43.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.39,43.73, ZIKA VIRUS BY PCR,87798,HCPCS,306,RC,,,,both,803.33,562.33,,,,,,,,,,,,,,,,,,,Other,173.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.39,173.2, ZIKA IGM,86790,HCPCS,302,RC,,,,both,547.72,383.4,,,,,,,,,,,,,,,,,,,Other,118.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.62,118.09, CHLAM PNEUMO PROBE,87486,HCPCS,306,RC,,,,both,115.38,80.77,,,,,,,,,,,,,,,,,,,Other,24.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.87,34.39, RESP VIRUS 12-25 TARGETS,87633,HCPCS,306,RC,,,,both,115.38,80.77,,,,,,,,,,,,,,,,,,,Other,24.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.87,113.07, LEGIONELLA IGM AB,86713,HCPCS,300,RC,,,,both,84.42,59.09,,,,,,,,,,,,,,,,,,,Other,18.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.99,18.2, T3 UPTAKE,84479,HCPCS,300,RC,,,,both,47.91,33.54,,,,,,,,,,,,,,,,,,,Other,10.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.34,10.33, RBC ANTIGEN SCREEN/UNIT,86902,HCPCS,300,RC,,,,both,156.47,109.53,,,,,,,,,,,,,,,,,,,Other,33.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.22,33.73, RBC ANTIGEN SCREEN/PATIENT,86905,HCPCS,300,RC,,,,both,156.47,109.53,,,,,,,,,,,,,,,,,,,Other,33.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.75,33.73, RBC ANTIGEN TIER 4,86902,HCPCS,300,RC,,,,both,405.61,283.93,,,,,,,,,,,,,,,,,,,Other,87.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.22,87.45, BLD TYPE-SERUM,86904,HCPCS,300,RC,,,,both,122.49,85.74,,,,,,,,,,,,,,,,,,,Other,26.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.01,26.41, RBC MOLECULAR TYPE,0001U,HCPCS,300,RC,,,,both,766.97,536.88,,,,,,,,,,,,,,,,,,,Other,165.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,705.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,165.36,705.6, FACTOR IX ASSAY,85250,HCPCS,300,RC,,,,both,152.18,106.53,,,,,,,,,,,,,,,,,,,Other,32.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.66,32.81, FACTOR XI ASSAY,85270,HCPCS,300,RC,,,,both,155.99,109.19,,,,,,,,,,,,,,,,,,,Other,33.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.54,33.63, FACTOR XII ASSAY,85280,HCPCS,300,RC,,,,both,156.29,109.4,,,,,,,,,,,,,,,,,,,Other,33.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.96,33.69, FACTOR X ASSAY,85260,HCPCS,300,RC,,,,both,156.58,109.61,,,,,,,,,,,,,,,,,,,Other,33.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.54,33.76, FACTOR XIII,85290,HCPCS,300,RC,,,,both,61.84,43.29,,,,,,,,,,,,,,,,,,,Other,13.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.33,16.01, TISSUE IHC ERA/PRA,88360,HCPCS,310,RC,,,,both,764.69,535.28,,,,,,,,,,,,,,,,,,,Other,110.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,110.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,110.38,110.38, BREAST RECEPTOR,88361,HCPCS,310,RC,,,,both,255.6,178.92,,,,,,,,,,,,,,,,,,,Other,105.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,105.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,105.58,105.58, TISSUE INSITU HYBRID,88365,HCPCS,310,RC,,,,both,388.11,271.68,,,,,,,,,,,,,,,,,,,Other,154.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,154.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,154.31,154.31, TISSUE INSITU HYBRID MAYO,88365,HCPCS,310,RC,,,,both,1432.86,1003,,,,,,,,,,,,,,,,,,,Other,154.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,154.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,154.31,154.31, FRZ SECTION,88331,HCPCS,310,RC,,,,both,388.11,271.68,,,,,,,,,,,,,,,,,,,Other,90.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,90.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,90.9,90.9, FROZEN SECTION (EA ADDN),88332,HCPCS,310,RC,,,,both,121.71,85.2,,,,,,,,,,,,,,,,,,,Other,49.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,49.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,49.89,49.89, GROSS EXAM,88300,HCPCS,310,RC,,,,both,115.86,81.1,,,,,,,,,,,,,,,,,,,Other,15.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.3,15.3, CYTOLOGY FINE NEEDLE ASPIRATE,88173,HCPCS,311,RC,,,,both,259.47,181.63,,,,,,,,,,,,,,,,,,,Other,154.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,154.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,154.07,154.07, CONSULTATION MAYO CLINIC,88321,HCPCS,310,RC,,,,both,598.23,418.76,,,,,,,,,,,,,,,,,,,Other,89.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,89.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,89.99,89.99, PATH CONSULT,88329,HCPCS,310,RC,,,,both,347.05,242.94,,,,,,,,,,,,,,,,,,,Other,49.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,49.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,49.32,49.32, MAYO CONSULT SLIDEPREP,88323,HCPCS,310,RC,,,,both,598.23,418.76,,,,,,,,,,,,,,,,,,,Other,106.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,106.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,106.51,106.51, MAYO COMP CONSULT,88325,HCPCS,310,RC,,,,both,598.23,418.76,,,,,,,,,,,,,,,,,,,Other,147.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,147.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,147.43,147.43, STONE ANALYSIS ( INFRARED SPEC ),82365,HCPCS,300,RC,,,,both,116.48,81.54,,,,,,,,,,,,,,,,,,,Other,25.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.64,25.12, DECALCIFICATION,88311,HCPCS,310,RC,,,,both,75.37,52.76,,,,,,,,,,,,,,,,,,,Other,18.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.71,18.71, SPECIAL STAINS GRP I,88312,HCPCS,312,RC,,,,both,189.26,132.48,,,,,,,,,,,,,,,,,,,Other,100.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,100.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,100.18,100.18, SPECIAL STAIN GROUP II (OTHER),88313,HCPCS,312,RC,,,,both,183.75,128.63,,,,,,,,,,,,,,,,,,,Other,73.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,73.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,73.4,73.4, MAYO SPEC STN II,88313,HCPCS,312,RC,,,,both,307.56,215.29,,,,,,,,,,,,,,,,,,,Other,73.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,73.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,73.4,73.4, FUNGAL STAIN,88312,HCPCS,310,RC,,,,both,189.26,132.48,,,,,,,,,,,,,,,,,,,Other,100.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,100.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,100.18,100.18, IMMUNOCYTOCHEM FIRST AB,88342,HCPCS,312,RC,,,,both,151.9,106.33,,,,,,,,,,,,,,,,,,,Other,100.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,100.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,100.98,100.98, IMMUNOCYTOCHEM FIRST G,88342,HCPCS,310,RC,,,,both,86.67,60.67,,,,,,,,,,,,,,,,,,,Other,100.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,84.94,100.98, IMMUNOCYTOCHEM EACH ADD AB G,88344,HCPCS,310,RC,,,,both,86.67,60.67,,,,,,,,,,,,,,,,,,,Other,157.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,84.94,157.66, IMMUNOCYTOCHEM EACH ADDITIONAL AB,88341,HCPCS,310,RC,,,,both,93.64,65.55,,,,,,,,,,,,,,,,,,,Other,86.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,86.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,86.05,86.05, IMMUNO PER SPEC;MULIPLEX AB,88344,HCPCS,312,RC,,,,both,151.9,106.33,,,,,,,,,,,,,,,,,,,Other,157.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,148.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,148.86,157.66, CYTOLOGY NONGYN,88108,HCPCS,310,RC,,,,both,152.33,106.63,,,,,,,,,,,,,,,,,,,Other,63.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,63.21,63.21, CYTO NGYN SPUTUM,88161,HCPCS,310,RC,,,,both,116.82,81.77,,,,,,,,,,,,,,,,,,,Other,76.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,76.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,76.15,76.15, CELLULAR ENHANCEMENT,88112,HCPCS,310,RC,,,,both,210.61,147.43,,,,,,,,,,,,,,,,,,,Other,60.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,60.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.56,60.56, PAP AUTO REVIEW,88175,HCPCS,311,RC,,,,both,125.03,87.52,,,,,,,,,,,,,,,,,,,Other,26.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.08,26.96, PAP SMEAR ROUTINE,88142,HCPCS,311,RC,,,,both,109.26,76.48,,,,,,,,,,,,,,,,,,,Other,23.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.85,23.56, PAP PATH REVIEW,88141,HCPCS,311,RC,,,,both,30.96,21.67,,,,,,,,,,,,,,,,,,,Other,22.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,22.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,22.44,22.44, PAP SMEAR LOW/HI,G0145,HCPCS,311,RC,,,,both,106.18,74.33,,,,,,,,,,,,,,,,,,,Other,22.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,25.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,22.89,25.96, PAP AUTO VERIFY,88174,HCPCS,311,RC,,,,both,254.11,177.88,,,,,,,,,,,,,,,,,,,Other,54.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.86,54.78, PAP SMEAR MANUAL SCREEN & RESCREEN,G0143,HCPCS,311,RC,,,,both,106.08,74.26,,,,,,,,,,,,,,,,,,,Other,22.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,22.87,26.51, PAP SMEAR LOW RISK FP R AND V,G0144,HCPCS,311,RC,,,,both,109.26,76.48,,,,,,,,,,,,,,,,,,,Other,23.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,43.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.56,43.09, PAP SMEAR THIN LAYER PHYSICIAN ITRP,G0124,HCPCS,311,RC,,,,both,106.08,74.26,,,,,,,,,,,,,,,,,,,Other,22.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,22.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,22.44,22.44, PAP SMEAR DIAGNOSITIC,88148,HCPCS,311,RC,,,,both,122.14,85.5,,,,,,,,,,,,,,,,,,,Other,26.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.17,26.33, TB QUANTIFERON,86480,HCPCS,300,RC,,,,both,208.85,146.2,,,,,,,,,,,,,,,,,,,Other,45.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,60.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,45.03,60.74, BRAIN NATRIURETIC PEPTIDE,83880,HCPCS,301,RC,,,,both,337,235.9,,,,,,,,,,,,,,,,,,,Other,72.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,38.47,72.66, CRYPTOCOCCAL AG-CSF,86403,HCPCS,300,RC,,,,both,80.05,56.04,,,,,,,,,,,,,,,,,,,Other,17.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.31,17.26, CRYPTOCOCCAL AG-SERUM,86403,HCPCS,300,RC,,,,both,80.05,56.04,,,,,,,,,,,,,,,,,,,Other,17.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.31,17.26, LEVEL 2 GROSS MICRO,88302,HCPCS,310,RC,,,,both,241,168.7,,,,,,,,,,,,,,,,,,,Other,29.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,29.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,29.78,29.78, LEVEL 3 GROSS MICRO,88304,HCPCS,310,RC,,,,both,203.99,142.79,,,,,,,,,,,,,,,,,,,Other,37.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,37.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,37.78,37.78, LEVEL 4 GROSS MICRO,88305,HCPCS,310,RC,,,,both,266.11,186.28,,,,,,,,,,,,,,,,,,,Other,65.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,65.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.27,65.27, LEVEL 5 GROSS MICRO,88307,HCPCS,310,RC,,,,both,531.96,372.37,,,,,,,,,,,,,,,,,,,Other,254.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,254.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,254.55,254.55, LEVEL 6 GROSS MICRO,88309,HCPCS,310,RC,,,,both,756.26,529.38,,,,,,,,,,,,,,,,,,,Other,379.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,379.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,379.88,379.88, PATH CONSULT SURG CYTO,88333,HCPCS,310,RC,,,,both,2211,1547.7,,,,,,,,,,,,,,,,,,,Other,82.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,82.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,82.87,82.87, TISSUE CX NEOPLASTIC,88239,HCPCS,310,RC,,,,both,2926.69,2048.68,,,,,,,,,,,,,,,,,,,Other,630.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,144.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,144.57,630.99, "BONE MARROW, TISSUE CULTURE",88237,HCPCS,310,RC,,,,both,515.63,360.94,,,,,,,,,,,,,,,,,,,Other,111.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,140.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,111.17,140.88, CYTOLOGY NGYN BRUSHING,88104,HCPCS,310,RC,,,,both,167.87,117.51,,,,,,,,,,,,,,,,,,,Other,77.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,77.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,77.52,77.52, "BONE MARROW, MSMART",88237,HCPCS,310,RC,,,,both,6731.28,4711.9,,,,,,,,,,,,,,,,,,,Other,1451.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,140.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,140.88,1451.26, BODY FLUID CRYSTALS,89060,HCPCS,300,RC,,,,both,83.94,58.76,,,,,,,,,,,,,,,,,,,Other,18.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.1,18.1, PLATELET AB (INDIRECT),86022,HCPCS,300,RC,,,,both,365.73,256.01,,,,,,,,,,,,,,,,,,,Other,78.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18,78.85, PLSMA CELL 1ST MARKER BM,88182,HCPCS,311,RC,,,,both,373.18,261.23,,,,,,,,,,,,,,,,,,,Other,136.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.7,136.7, FLOW CYTOMETRY FIRST MARKER,88184,HCPCS,311,RC,,,,both,226.84,158.79,,,,,,,,,,,,,,,,,,,Other,73.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,73.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,73.05,73.05, FLOW CYTOMETRY EACH ADD MARKER,88185,HCPCS,311,RC,,,,both,76.81,53.77,,,,,,,,,,,,,,,,,,,Other,20.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.62,20.62, "CD4 AND CD8, ABSOLUTE COUNT",86360,HCPCS,300,RC,,,,both,83.74,58.62,,,,,,,,,,,,,,,,,,,Other,18.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,46.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.05,46.04, CD4 COUNT,86361,HCPCS,300,RC,,,,both,80.62,56.43,,,,,,,,,,,,,,,,,,,Other,17.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.39,26.24, B CELLS TOTAL,86355,HCPCS,300,RC,,,,both,99.16,69.41,,,,,,,,,,,,,,,,,,,Other,21.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,21.38,36.98, NATURAL KILLER CELLS,86357,HCPCS,300,RC,,,,both,99.16,69.41,,,,,,,,,,,,,,,,,,,Other,21.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,21.38,36.98, T CELLS TOTAL,86359,HCPCS,300,RC,,,,both,99.16,69.41,,,,,,,,,,,,,,,,,,,Other,21.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,21.38,36.98, NEUTROPHIL OXIDATIVE BURST,86352,HCPCS,300,RC,,,,both,317.82,222.47,,,,,,,,,,,,,,,,,,,Other,68.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,133.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,68.52,133.14, CHRONIC URTICARIA INDEX,86352,HCPCS,302,RC,,,,both,277.89,194.52,,,,,,,,,,,,,,,,,,,Other,59.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,133.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,59.92,133.14, ADALIMUMAB ACTIVITY,80299,HCPCS,300,RC,,,,both,892.41,624.69,,,,,,,,,,,,,,,,,,,Other,192.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.27,192.4, ADALIMUMAB ANTIBODY,82397,HCPCS,300,RC,,,,both,676.21,473.35,,,,,,,,,,,,,,,,,,,Other,145.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.84,145.79, FLOWCYTO INT 2-8 MARK,88187,HCPCS,311,RC,,,,both,99.11,69.38,,,,,,,,,,,,,,,,,,,Other,34.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.06,34.06, FLOWCYTO CELL CYCLE DNA,88182,HCPCS,311,RC,,,,both,136.95,95.87,,,,,,,,,,,,,,,,,,,Other,136.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,134.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,134.21,136.7, PLSMA CELL 1ST SURF MARK BM,88184,HCPCS,311,RC,,,,both,764.69,535.28,,,,,,,,,,,,,,,,,,,Other,73.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,73.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,73.05,73.05, ISLET AG 2 AB,86341,HCPCS,302,RC,,,,both,793.11,555.18,,,,,,,,,,,,,,,,,,,Other,170.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.1,170.99, GAD ANTIBODY,86341,HCPCS,302,RC,,,,both,93.37,65.36,,,,,,,,,,,,,,,,,,,Other,20.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.13,23.1, CHROMOGRANIN A,86316,HCPCS,302,RC,,,,both,190.16,133.11,,,,,,,,,,,,,,,,,,,Other,41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.39,41, DES GAMMA CARBOXY PROTHROMBIN,83951,HCPCS,301,RC,,,,both,337.65,236.36,,,,,,,,,,,,,,,,,,,Other,72.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,63.12,72.79, ID MALDI-TOF MASS SPEC AFB,87118,HCPCS,300,RC,,,,both,322.13,225.49,,,,,,,,,,,,,,,,,,,Other,69.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.32,69.45, PTH RELATED PEPTIDE,82397,HCPCS,301,RC,,,,both,105.52,73.86,,,,,,,,,,,,,,,,,,,Other,22.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.84,22.75, FIBROTEST-ACTITEST,81596,HCPCS,300,RC,,,,both,503.87,352.71,,,,,,,,,,,,,,,,,,,Other,108.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,70.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,70.75,108.63, "Carbamazepine-10,11-Epoxide",80161,HCPCS,300,RC,,,,both,295,206.5,,,,,,,,,,,,,,,,,,,Other,63.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.27,63.6, "DIHYDROTESTOSTERONE, SERUM",82642,HCPCS,300,RC,,,,both,115.18,80.63,,,,,,,,,,,,,,,,,,,Other,24.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,28.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.83,28.69, SARS-CoV-2 PCR,87635,HCPCS,300,RC,,,,both,192.05,134.44,,,,,,,,,,,,,,,,,,,Other,41.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,50.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,41.4,50.28, ZINC TRANSPORTER 8 ANTIBODY,86341,HCPCS,300,RC,,,,both,509.36,356.55,,,,,,,,,,,,,,,,,,,Other,109.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.1,109.82, SARS COV-2 IGG,86769,HCPCS,300,RC,,,,both,73.73,51.61,,,,,,,,,,,,,,,,,,,Other,15.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,41.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.9,41.29, SARS-CoV-2 PCR (HMC),87635,HCPCS,300,RC,,,,both,233.66,163.56,,,,,,,,,,,,,,,,,,,Other,50.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,50.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,50.28,50.38, MRSA SCREEN MOLECULAR,87641,HCPCS,300,RC,,,,both,277.25,194.08,,,,,,,,,,,,,,,,,,,Other,59.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.39,59.78, SARS RAPID ANTIGEN,87426,HCPCS,300,RC,,,,both,144.1,100.87,,,,,,,,,,,,,,,,,,,Other,31.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.07,34.62, RESP 4PLEX PANEL,87631,HCPCS,300,RC,,,,both,293.24,205.27,,,,,,,,,,,,,,,,,,,Other,63.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,139.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,63.22,139.78, CYTOGEN/MOLECULAR INTERP/REPORT,88291,HCPCS,319,RC,,,,both,105.99,74.19,,,,,,,,,,,,,,,,,,,Other,31.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,31.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.47,31.47, PRE OP Staph PCR,87640,HCPCS,300,RC,,,,both,322.77,225.94,,,,,,,,,,,,,,,,,,,Other,69.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.39,69.59, M PROTEIN MALDI,0077U,HCPCS,300,RC,,,,both,845.91,592.14,,,,,,,,,,,,,,,,,,,Other,182.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,42.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,42.56,182.38, LAMBDA FREE LIGHT CHAINS,83520,HCPCS,300,RC,,,,both,672.83,470.98,,,,,,,,,,,,,,,,,,,Other,145.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.92,145.06, KAPPA FREE LIGHT CHAINS,83520,HCPCS,300,RC,,,,both,672.83,470.98,,,,,,,,,,,,,,,,,,,Other,145.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.92,145.06, BM ASP INTERP,85097,HCPCS,310,RC,,,,both,902.04,631.43,,,,,,,,,,,,,,,,,,,Other,64.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,64.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,64.35,64.35, HOMOCYSTINE URINE,82131,HCPCS,300,RC,,,,both,167.68,117.38,,,,,,,,,,,,,,,,,,,Other,36.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,22.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,22.52,36.15, CYSTINE URINE,82136,HCPCS,301,RC,,,,both,254.35,178.05,,,,,,,,,,,,,,,,,,,Other,54.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.22,54.84, NUCLEAR ANTIGEN ANTIBODY,86235,HCPCS,302,RC,,,,both,93.51,65.46,,,,,,,,,,,,,,,,,,,Other,20.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.57,20.16, "IGF-1, LC/MS, S",84305,HCPCS,300,RC,,,,both,56.64,39.65,,,,,,,,,,,,,,,,,,,Other,12.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.21,20.83, INTERPHASE INSITU HYBRIDIZATION,88274,HCPCS,311,RC,,,,both,113.92,79.74,,,,,,,,,,,,,,,,,,,Other,24.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,41.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.56,41.53, IN SITU HYBRID 100 TO 300 CELLS,88275,HCPCS,311,RC,,,,both,192.49,134.74,,,,,,,,,,,,,,,,,,,Other,41.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,50.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,41.5,50.17, AUTO ALERT,150,RC,,,,,,both,20,14,,,,,,,,,,,,,,,,,,,Per Diem,2826.98,,Reimbursement is subject to Medicare Sequestration.,,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,,,,,,,,,,2826.98,2826.98, MYCOPLASMA PN IgM,86738,HCPCS,300,RC,,,,both,74.5,52.15,,,,,,,,,,,,,,,,,,,Other,16.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.98,16.06, EBV ABS-EBNA,86664,HCPCS,300,RC,,,,both,61.35,42.95,,,,,,,,,,,,,,,,,,,Other,13.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.23,14.98, WEST NILE VIRUS IGM,86788,HCPCS,300,RC,,,,both,194.09,135.86,,,,,,,,,,,,,,,,,,,Other,41.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.51,41.85, ALK PHOS ISOS (TOTAL),84075,HCPCS,301,RC,,,,both,50.24,35.17,,,,,,,,,,,,,,,,,,,Other,10.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.08,10.83, HERPES SIMPLEX IgG TYPE II,86696,HCPCS,300,RC,,,,both,68.81,48.17,,,,,,,,,,,,,,,,,,,Other,14.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.84,18.96, FROZ EST RECEPTOR,84233,HCPCS,300,RC,,,,both,258.42,180.89,,,,,,,,,,,,,,,,,,,Other,55.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,86.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,55.71,86.12, INFLUENZA A AB IgM,86710,HCPCS,300,RC,,,,both,125.9,88.13,,,,,,,,,,,,,,,,,,,Other,27.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.28,27.15, TOXOPLASMOSIS ABS IgM,86778,HCPCS,300,RC,,,,both,77.44,54.21,,,,,,,,,,,,,,,,,,,Other,16.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.12,16.7, B2 GLYCOPROTEIN 1 AB IGA,86146,HCPCS,302,RC,,,,both,25.45,17.82,,,,,,,,,,,,,,,,,,,Other,5.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.49,24.94, CARDIOLIPIN AB-IgM,86147,HCPCS,300,RC,,,,both,113.92,79.74,,,,,,,,,,,,,,,,,,,Other,24.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.56,24.94, FACT VIII (RISTCTN),85245,HCPCS,300,RC,,,,both,129.41,90.59,,,,,,,,,,,,,,,,,,,Other,27.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,22.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,22.48,27.9, INFLVENZA B ANTIBODY IGM,86710,HCPCS,300,RC,,,,both,125.9,88.13,,,,,,,,,,,,,,,,,,,Other,27.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.28,27.15, PSA - DIAGNOSTIC,84153,HCPCS,301,RC,,,,both,151.32,105.92,,,,,,,,,,,,,,,,,,,Other,32.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.02,32.62, PSA - REFERRED,84153,HCPCS,301,RC,,,,both,151.32,105.92,,,,,,,,,,,,,,,,,,,Other,32.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.02,32.62, UNSCHED DIALYSIS ESRD PT HOS,G0257,HCPCS,301,RC,,,,both,0.01,0.01,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ROCKY MTN IgM,86757,HCPCS,300,RC,,,,both,91.85,64.3,,,,,,,,,,,,,,,,,,,Other,19.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.96,19.81, THYROGLOBULIN ANTIBODY,86800,HCPCS,300,RC,,,,both,67.19,47.03,,,,,,,,,,,,,,,,,,,Other,14.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.48,15.59, EBV ABS-VCA IgG,86665,HCPCS,300,RC,,,,both,68.81,48.17,,,,,,,,,,,,,,,,,,,Other,14.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.84,17.78, B2 GLYCOPROTEIN 1 AB IGM,86146,HCPCS,302,RC,,,,both,25.45,17.82,,,,,,,,,,,,,,,,,,,Other,5.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.49,24.94, CARDIOLIPIN AB - IGA,86147,HCPCS,300,RC,,,,both,113.92,79.74,,,,,,,,,,,,,,,,,,,Other,24.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.56,24.94, PHOSPHATIDYLSERINE AB IGA,86148,HCPCS,300,RC,,,,both,81.75,57.23,,,,,,,,,,,,,,,,,,,Other,17.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.75,17.63, FACT VIII vWF/Ag,85246,HCPCS,300,RC,,,,both,101.13,70.79,,,,,,,,,,,,,,,,,,,Other,21.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,22.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,21.8,22.48, EBV ABS-VCA IgM,86665,HCPCS,300,RC,,,,both,71.56,50.09,,,,,,,,,,,,,,,,,,,Other,15.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.43,17.78, HEPB SCREEN HIGH RISK INDIV MEDICARE,G0499,HCPCS,300,RC,,,,both,171.83,120.28,,,,,,,,,,,,,,,,,,,Other,37.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.7,37.04, HUMAN EPIDIDYMIS PROTEIN 4,86305,HCPCS,300,RC,,,,both,374.3,262.01,,,,,,,,,,,,,,,,,,,Other,80.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.39,80.7, HISTOCHEMICAL STAINS ADD-ON,88314,HCPCS,310,RC,,,,both,160.38,112.27,,,,,,,,,,,,,,,,,,,Other,75.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,75.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,75.11,75.11, ENZYME HISTOCHEMISTRY,88319,HCPCS,310,RC,,,,both,217.67,152.37,,,,,,,,,,,,,,,,,,,Other,120.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,120.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,120.17,120.17, FLOW CYTOMETRY INTERPRETATION 16/> MARKE,88189,HCPCS,310,RC,,,,both,308.15,215.71,,,,,,,,,,,,,,,,,,,Other,77.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,77.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,77.05,77.05, FLOW CYTOMETRY INTERP 9-15 MARKERS,88188,HCPCS,310,RC,,,,both,235.11,164.58,,,,,,,,,,,,,,,,,,,Other,56.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,56.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,56.91,56.91, AMINOLEVULINIC ACID DELTA,82135,HCPCS,301,RC,,,,both,213.67,149.57,,,,,,,,,,,,,,,,,,,Other,46.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.12,46.07, PORPHOBILINOGEN URINE; QUAN,84110,HCPCS,301,RC,,,,both,94.07,65.85,,,,,,,,,,,,,,,,,,,Other,20.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.27,20.29, CRYOGLOBULIN QUANT,82595,HCPCS,301,RC,,,,both,46.46,32.52,,,,,,,,,,,,,,,,,,,Other,10.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.34,10.02, GALOP CHG,83520,HCPCS,301,RC,,,,both,782.69,547.88,,,,,,,,,,,,,,,,,,,Other,168.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.92,168.75, CYSTATIN C,82610,HCPCS,300,RC,,,,both,389.4,272.58,,,,,,,,,,,,,,,,,,,Other,83.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,18.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.15,83.96, ASPERGILLIS ANTIGEN,87305,HCPCS,300,RC,,,,both,242,169.4,,,,,,,,,,,,,,,,,,,Other,52.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.74,52.18, OBSTETRIC PANEL,80055,HCPCS,300,RC,,,,both,485.5,339.85,,,,,,,,,,,,,,,,,,,Other,104.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,46.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,46.85,104.67, ASPERGILLIS ANTIGEN,87305,HCPCS,300,RC,,,,both,242,169.4,,,,,,,,,,,,,,,,,,,Other,52.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.74,52.18, OBSTETRIC PANEL,80055,HCPCS,300,RC,,,,both,485.5,339.85,,,,,,,,,,,,,,,,,,,Other,104.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,46.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,46.85,104.67, NM AORTOGRAM,78499,HCPCS,341,RC,,,,both,1214.68,850.28,,,,,,,,,,,,,,,,,,,Other,261.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,261.89,261.89, NM LABEL WHITE BLOOD CELL SCAN,78800,HCPCS,341,RC,,,,both,4047.57,2833.3,,,,,,,,,,,,,,,,,,,Other,872.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,211.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,211.3,872.66, NM BONE MARROW,78104,HCPCS,341,RC,,,,both,1433.78,1003.65,,,,,,,,,,,,,,,,,,,Other,309.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,201.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,201.76,309.12, NM BONE SCAN 3 PHASE,78315,HCPCS,341,RC,,,,both,1282.25,897.58,,,,,,,,,,,,,,,,,,,Other,276.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,276.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,276.3,276.46, NM BONE JOINT SPECT,78803,HCPCS,341,RC,,,,both,2098.22,1468.75,,,,,,,,,,,,,,,,,,,Other,452.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,305.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,305.5,452.38, NM BONE TOTAL,78306,HCPCS,341,RC,,,,both,1398.81,979.17,,,,,,,,,,,,,,,,,,,Other,301.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,236,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,236,301.59, "XR spine, thoracolum junc 2VW+",72080,HCPCS,320,RC,,,,both,402.24,281.57,,,,,,,,,,,,,,,,,,,Other,86.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,32.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,32.38,86.72, XR Spine; 1 VW Scoliotic exam,72081,HCPCS,320,RC,,,,both,413.91,289.74,,,,,,,,,,,,,,,,,,,Other,89.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,40.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,40.8,89.24, XR spine; 2 or 3 VW scoliotic exam,72082,HCPCS,320,RC,,,,both,478.06,334.64,,,,,,,,,,,,,,,,,,,Other,103.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,65.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.75,103.07, XR spine; 4 or 5 VW scoliotic exxam,72083,HCPCS,320,RC,,,,both,736.47,515.53,,,,,,,,,,,,,,,,,,,Other,158.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,73.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,73.03,158.78, XR spine; min 6VW scoliotic exam,72084,HCPCS,320,RC,,,,both,736.47,515.53,,,,,,,,,,,,,,,,,,,Other,158.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,90.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,90.15,158.78, XR HIP UNILAT 1 VW,73501,HCPCS,320,RC,,,,both,413.91,289.74,,,,,,,,,,,,,,,,,,,Other,89.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,31.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.12,89.24, XR HIP UNILAT 2-3 VWS,73502,HCPCS,320,RC,,,,both,413.91,289.74,,,,,,,,,,,,,,,,,,,Other,89.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,44.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,44.66,89.24, XR HIP UNILAT MIN 4 VW,73503,HCPCS,320,RC,,,,both,464.59,325.21,,,,,,,,,,,,,,,,,,,Other,100.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,57.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,57.57,100.17, "XR HIP BILATERAL 2V,BILATERAL PROCEDURE",73521,HCPCS,320,RC,50,,,both,464.59,325.21,,,,,,,,,,,,,,,,,,,Other,100.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,38.38,100.17, "XR HIP BILATERAL 3-4V,BILATERAL PROCEDURE",73522,HCPCS,320,RC,50,,,both,464.59,325.21,,,,,,,,,,,,,,,,,,,Other,100.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,50.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,50.15,100.17, "XR HIP BILATERAL 5V,BILATERAL PROCEDURE",73523,HCPCS,320,RC,50,,,both,715.72,501,,,,,,,,,,,,,,,,,,,Other,154.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,56.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,56.48,154.31, "XR FEMUR 1V BILATERAL,BILATERAL PROCEDURE",73551,HCPCS,320,RC,50,,,both,413.91,289.74,,,,,,,,,,,,,,,,,,,Other,89.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,54.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,54.35,89.24, "XR FEMUR 2V BILATERAL,BILATERAL PROCEDURE",73552,HCPCS,320,RC,50,,,both,413.91,289.74,,,,,,,,,,,,,,,,,,,Other,89.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,65.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.84,89.24, NM BOWEL MECKELS STUDY,78290,HCPCS,341,RC,,,,both,2150.68,1505.48,,,,,,,,,,,,,,,,,,,Other,463.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,264.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,264.09,463.69, NM MIRALUMA,78800,HCPCS,340,RC,,,,both,1260.23,882.16,,,,,,,,,,,,,,,,,,,Other,271.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,211.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,211.3,271.7, NM CARDC BLD PL,78472,HCPCS,341,RC,,,,both,1516.78,1061.75,,,,,,,,,,,,,,,,,,,Other,327.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,190.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,190.02,327.02, NM MYOCARDIAL SPECT STRESS TEST,78452,HCPCS,341,RC,,,,both,4323.67,3026.57,,,,,,,,,,,,,,,,,,,Other,932.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,390.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,390.09,932.19, NM MYOCARD SPECT 2 DAY PROTOCOL,78451,HCPCS,341,RC,,,,both,4323.39,3026.37,,,,,,,,,,,,,,,,,,,Other,932.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,284.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,284.5,932.13, NM JOINT LMTD AREA,78300,HCPCS,341,RC,,,,both,1214.68,850.28,,,,,,,,,,,,,,,,,,,Other,261.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,181.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,181.4,261.89, NM JOINT MLTP AREA,78305,HCPCS,341,RC,,,,both,1226.35,858.45,,,,,,,,,,,,,,,,,,,Other,264.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,221.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,221.49,264.4, NM LIVER AND SPLEEN,78215,HCPCS,341,RC,,,,both,1894.44,1326.11,,,,,,,,,,,,,,,,,,,Other,408.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,162.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,162.44,408.44, NM HEPATOBILIARY HIDA SCAN WO CCK,78226,HCPCS,341,RC,,,,both,1635.88,1145.12,,,,,,,,,,,,,,,,,,,Other,352.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,258.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,258.89,352.69, NM HEPATOBILIARY HIDA SCAN WITH CCK,78227,HCPCS,341,RC,,,,both,1685.31,1179.72,,,,,,,,,,,,,,,,,,,Other,363.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,347.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,347.55,363.35, NM LUNG PRFSN STDY,78580,HCPCS,341,RC,,,,both,1348.25,943.78,,,,,,,,,,,,,,,,,,,Other,290.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,191.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,191.13,290.69, NM LUNG VENTILATION,78579,HCPCS,341,RC,,,,both,1214.68,850.28,,,,,,,,,,,,,,,,,,,Other,261.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,151.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,151.47,261.89, NM LUNG VENT AND PERF VQ,78582,HCPCS,341,RC,,,,both,547.72,383.4,,,,,,,,,,,,,,,,,,,Other,118.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,265.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,118.09,265.31, NM LUNG QUANTITATIVE,78598,HCPCS,341,RC,,,,both,1611.63,1128.14,,,,,,,,,,,,,,,,,,,Other,347.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,241.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,241.27,347.47, NM MUGA SCAN,78473,HCPCS,341,RC,,,,both,1672.97,1171.08,,,,,,,,,,,,,,,,,,,Other,360.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,245.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,245.2,360.69, NM RENAL,78700,HCPCS,341,RC,,,,both,1483.08,1038.16,,,,,,,,,,,,,,,,,,,Other,319.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,139.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,139.7,319.75, NM RENL W ARTFLW,78701,HCPCS,341,RC,,,,both,1645.99,1152.19,,,,,,,,,,,,,,,,,,,Other,354.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,184.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,184.55,354.88, SITZ MARK NON RAD CONTRAST MATERIALNOC,A9698,HCPCS,250,RC,,,,both,95.52,66.86,,,,,,,,,,,,,,,,,,,Other,20.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.59,20.59, NM RENAL DOSE (TC MAG3),A9562,HCPCS,343,RC,,1,EA,both,446.56,312.59,,,,,,,,,,,,,,,,,,,Other,96.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,96.28,96.28, NM LUNG VENTIL DOSE(DTPA) <=25.00 mci,A9539,HCPCS,343,RC,,1,EA,both,493.15,345.21,,,,,,,,,,,,,,,,,,,Other,106.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,106.32,106.32, NM TCMAA-1 LUNG PERFUSION <=10.00 mci,A9540,HCPCS,343,RC,,1,EA,both,491.24,343.87,,,,,,,,,,,,,,,,,,,Other,105.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,105.91,105.91, NM RENAL W PHARMACY,78708,HCPCS,340,RC,,1,EA,both,1672.07,1170.45,,,,,,,,,,,,,,,,,,,Other,360.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,159.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,159.91,360.5, NM Tc99m Sulfur Colloid,A9541,HCPCS,343,RC,,1,EA,both,578.64,405.05,,,,,,,,,,,,,,,,,,,Other,124.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,124.75,124.75, NM SPLEEN W FLOW,78185,HCPCS,341,RC,,,,both,1260.23,882.16,,,,,,,,,,,,,,,,,,,Other,271.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,140.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,140.25,271.7, NM THYROID,78013,HCPCS,340,RC,,,,both,1385.99,970.19,,,,,,,,,,,,,,,,,,,Other,298.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,150.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,150.62,298.82, NM PARATHYROID IMAGING,78070,HCPCS,341,RC,,,,both,1260.23,882.16,,,,,,,,,,,,,,,,,,,Other,271.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,237.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,237.33,271.7, NM THYROID UPTAKE,78012,HCPCS,340,RC,,,,both,1260.23,882.16,,,,,,,,,,,,,,,,,,,Other,271.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,73.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,73.12,271.7, NM THYROID MET SCAN WHOLE BODY,78018,HCPCS,341,RC,,,,both,1619.12,1133.38,,,,,,,,,,,,,,,,,,,Other,349.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,250.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,250.86,349.09, NM THYROID UPTAKE&SCN,78014,HCPCS,340,RC,,,,both,1260.23,882.16,,,,,,,,,,,,,,,,,,,Other,271.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,191.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,191.46,271.7, NM SHUNT EVALUATION,78645,HCPCS,341,RC,,,,both,1260.23,882.16,,,,,,,,,,,,,,,,,,,Other,271.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,258.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,258.51,271.7, NM TESTICULAR IMAGING W VASCULAR FLOW,78761,HCPCS,341,RC,,,,both,1300.27,910.19,,,,,,,,,,,,,,,,,,,Other,280.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,173.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,173.71,280.34, NM VENOGRAM,78458,HCPCS,341,RC,,,,both,1260.23,882.16,,,,,,,,,,,,,,,,,,,Other,271.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,170.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,170.88,271.7, NM VENOGRAM LUNG,78445,HCPCS,341,RC,,,,both,1392.4,974.68,,,,,,,,,,,,,,,,,,,Other,300.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,152.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,152.28,300.2, NM VOIDING CYSTO,78740,HCPCS,341,RC,,,,both,1260.23,882.16,,,,,,,,,,,,,,,,,,,Other,271.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,200.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,200.41,271.7, NM LYMPHOSCINTIGRAPY,78195,HCPCS,341,RC,,,,both,2324.34,1627.04,,,,,,,,,,,,,,,,,,,Other,501.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,284.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,284.5,501.12, NM PAROTID,78230,HCPCS,341,RC,,,,both,1245.04,871.53,,,,,,,,,,,,,,,,,,,Other,268.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,144.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,144.1,268.43, NM GASTRIC REFLUX STUDY,78262,HCPCS,340,RC,,,,both,1291.73,904.21,,,,,,,,,,,,,,,,,,,Other,278.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,198.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,198.14,278.5, NM GI BLEED LOC,78278,HCPCS,341,RC,,,,both,1245.04,871.53,,,,,,,,,,,,,,,,,,,Other,268.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,278.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,268.43,278.34, NM GASTRIC EMPTYING STUDY,78264,HCPCS,341,RC,,,,both,1264.77,885.34,,,,,,,,,,,,,,,,,,,Other,272.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,263.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,263.51,272.68, NM ABSESSES INFEC WHOLE BODY,78802,HCPCS,341,RC,,,,both,4199.35,2939.55,,,,,,,,,,,,,,,,,,,Other,905.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,245.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,245.7,905.38, US GUIDE INTRAOP,76998,HCPCS,402,RC,,,,both,810.66,567.46,,,,,,,,,,,,,,,,,,,Other,174.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,174.78,174.78, SONO SCROTUM,76870,HCPCS,402,RC,,,,both,1069,748.3,,,,,,,,,,,,,,,,,,,Other,230.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,90.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,90.99,230.48, SONO GUIDED NEEDLE PLACEMENT,76942,HCPCS,402,RC,,,,both,574.81,402.37,,,,,,,,,,,,,,,,,,,Other,123.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,60.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.08,123.93, SONO LLQ RLQ,76705,HCPCS,402,RC,,,,both,1010.95,707.67,,,,,,,,,,,,,,,,,,,Other,217.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,79.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,79.61,217.96, SONO PELVIC,76856,HCPCS,402,RC,,,,both,1010.95,707.67,,,,,,,,,,,,,,,,,,,Other,217.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,97.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,97.11,217.96, SONO POST VOID RESIDUAL,76857,HCPCS,402,RC,,,,both,697,487.9,,,,,,,,,,,,,,,,,,,Other,150.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,47.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,47.97,150.27, SONO RETROPEROTINEAL,76770,HCPCS,402,RC,,,,both,1169.8,818.86,,,,,,,,,,,,,,,,,,,Other,252.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,98.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,98.15,252.21, SONO ABDOMINAL AORTA,76775,HCPCS,402,RC,,,,both,952,666.4,,,,,,,,,,,,,,,,,,,Other,205.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,56.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,56.87,205.25, SONO SPLEEN,76705,HCPCS,402,RC,,,,both,1010.95,707.67,,,,,,,,,,,,,,,,,,,Other,217.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,79.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,79.61,217.96, SONO PANCREAS,76705,HCPCS,402,RC,,,,both,1010.95,707.67,,,,,,,,,,,,,,,,,,,Other,217.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,79.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,79.61,217.96, SONO KIDNEYS BILATERAL,76775,HCPCS,402,RC,,,,both,952,666.4,,,,,,,,,,,,,,,,,,,Other,205.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,56.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,56.87,205.25, "SONO KIDNEY RIGHT,RIGHT",76775,HCPCS,402,RC,RT,,,both,952,666.4,,,,,,,,,,,,,,,,,,,Other,205.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,56.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,56.87,205.25, "SONO KIDNEY LEFT,LEFT",76775,HCPCS,402,RC,LT,,,both,952,666.4,,,,,,,,,,,,,,,,,,,Other,205.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,56.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,56.87,205.25, SONO GALL BLADDR,76705,HCPCS,402,RC,,,,both,1010.95,707.67,,,,,,,,,,,,,,,,,,,Other,217.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,79.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,79.61,217.96, SONO LIVER,76705,HCPCS,402,RC,,,,both,1010.95,707.67,,,,,,,,,,,,,,,,,,,Other,217.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,79.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,79.61,217.96, SONO ABDOMEN COMPLETE,76700,HCPCS,402,RC,,,,both,1359,951.3,,,,,,,,,,,,,,,,,,,Other,293,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,105.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,105.73,293, SONO ABDMEN LMTD,76705,HCPCS,402,RC,,,,both,1010.95,707.67,,,,,,,,,,,,,,,,,,,Other,217.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,79.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,79.61,217.96, SONO THYROID,76536,HCPCS,402,RC,,,,both,979,685.3,,,,,,,,,,,,,,,,,,,Other,211.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,99.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,99.55,211.07, SONO PAROTID,76536,HCPCS,402,RC,,,,both,979,685.3,,,,,,,,,,,,,,,,,,,Other,211.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,99.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,99.55,211.07, SONO TRANSVAGINAL,76830,HCPCS,402,RC,,,,both,950,665,,,,,,,,,,,,,,,,,,,Other,204.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,108.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,108.38,204.82, SONO EXTREMITY NON VASCULAR,76882,HCPCS,402,RC,,,,both,659,461.3,,,,,,,,,,,,,,,,,,,Other,142.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,60.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.35,142.08, "SONO NECK BILATERAL,BILATERAL PROCEDURE",76536,HCPCS,402,RC,50,,,both,979,685.3,,,,,,,,,,,,,,,,,,,Other,211.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,99.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,99.55,211.07, "SONO NECK RIGHT,RIGHT",76536,HCPCS,402,RC,RT,,,both,979,685.3,,,,,,,,,,,,,,,,,,,Other,211.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,99.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,99.55,211.07, "SONO NECK LEFT,LEFT",76536,HCPCS,402,RC,LT,,,both,979,685.3,,,,,,,,,,,,,,,,,,,Other,211.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,99.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,99.55,211.07, SONO CHEST,76604,HCPCS,402,RC,,,,both,757,529.9,,,,,,,,,,,,,,,,,,,Other,163.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,57.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,57.41,163.21, "SONO BREAST RIGHT COMPLETE,RIGHT",76641,HCPCS,402,RC,RT,,,both,1010.95,707.67,,,,,,,,,,,,,,,,,,,Other,217.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,92.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,92.74,217.96, "SONO BREAST LEFT COMPLETE,LEFT",76641,HCPCS,402,RC,LT,,,both,1010.95,707.67,,,,,,,,,,,,,,,,,,,Other,217.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,92.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,92.74,217.96, "SONO BREAST RIGHT,RIGHT",76642,HCPCS,402,RC,RT,,,both,906,634.2,,,,,,,,,,,,,,,,,,,Other,195.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,77.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,77.66,195.33, "SONO BREAST LEFT LIMITED,LEFT",76642,HCPCS,402,RC,LT,,,both,906,634.2,,,,,,,,,,,,,,,,,,,Other,195.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,77.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,77.66,195.33, "XR FOOT LEFT,LEFT",73630,HCPCS,320,RC,LT,,,both,304.51,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,31.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.39,65.65, "XR FOOT RIGHT,RIGHT",73630,HCPCS,320,RC,RT,,,both,304.51,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,31.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.39,65.65, XR FOOT 2 VIEW,73620,HCPCS,320,RC,,,,both,304.51,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.58,65.65, "XR ANKLE RT 3V,RIGHT",73610,HCPCS,320,RC,RT,,,both,377.72,264.4,,,,,,,,,,,,,,,,,,,Other,81.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.08,81.44, "XR ANKLE LT 3V,LEFT",73610,HCPCS,320,RC,LT,,,both,377.13,263.99,,,,,,,,,,,,,,,,,,,Other,81.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.08,81.31, "XR TIB/FIB RT,RIGHT",73590,HCPCS,320,RC,RT,,,both,405.47,283.83,,,,,,,,,,,,,,,,,,,Other,87.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,28.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,28.97,87.42, "XR TIB/FIB LT,LEFT",73590,HCPCS,320,RC,LT,,,both,405.47,283.83,,,,,,,,,,,,,,,,,,,Other,87.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,28.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,28.97,87.42, XR KNEE STDG AP BILT,73565,HCPCS,320,RC,,,,both,304.52,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,38.53,65.65, "XR KNEE 4V+ LEFT,LEFT",73564,HCPCS,320,RC,LT,,,both,432.48,302.74,,,,,,,,,,,,,,,,,,,Other,93.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,45.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,45.26,93.25, "XR KNEE 4V+ RIGHT,RIGHT",73564,HCPCS,320,RC,RT,,,both,432.48,302.74,,,,,,,,,,,,,,,,,,,Other,93.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,45.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,45.26,93.25, "XR KNEE 1/2 VIEWS LEFT,LEFT",73560,HCPCS,320,RC,LT,,,both,304.52,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,31.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.66,65.65, "XR KNEE 1/2 VIEWS RIGHT,RIGHT",73560,HCPCS,320,RC,RT,,,both,304.52,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,31.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.66,65.65, "XR KNEE 3V LT,LEFT",73562,HCPCS,320,RC,LT,,,both,392.57,274.8,,,,,,,,,,,,,,,,,,,Other,84.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,38.9,84.64, "XR KNEE 3V RT,RIGHT",73562,HCPCS,320,RC,RT,,,both,392.57,274.8,,,,,,,,,,,,,,,,,,,Other,84.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,38.9,84.64, "XR KNEE BILATERAL,BILATERAL PROCEDURE",73560,HCPCS,320,RC,50,,,both,456.78,319.75,,,,,,,,,,,,,,,,,,,Other,98.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,63.33,98.48, "XR TOE LEFT GREAT TOE,LT GREAT TOE, LEFT",73660,HCPCS,320,RC,"TA,LT",,,both,304.51,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.5,65.65, "XR TOE RIGHT 5TH,RT 5TH TOE",73660,HCPCS,320,RC,T9,,,both,304.51,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.5,65.65, XR PELVIS 1/2 VWS,72170,HCPCS,320,RC,,,,both,427.65,299.36,,,,,,,,,,,,,,,,,,,Other,92.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.01,92.2, XR SKELETAL SURVEY,77075,HCPCS,320,RC,,,,both,1025.68,717.98,,,,,,,,,,,,,,,,,,,Other,221.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,90.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,90.17,221.14, XR BONE AGE,77072,HCPCS,320,RC,,,,both,386.28,270.4,,,,,,,,,,,,,,,,,,,Other,83.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.68,83.28, XR STRNO CLVCLR JN,71130,HCPCS,320,RC,,,,both,323.34,226.34,,,,,,,,,,,,,,,,,,,Other,69.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,38.08,69.71, "XR TOE LEFT 2ND,LEFT 2ND TOE",73660,HCPCS,320,RC,T1,,,both,304.51,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.5,65.65, XR HAND MIN 3 VWS,73130,HCPCS,320,RC,,,,both,242.58,169.81,,,,,,,,,,,,,,,,,,,Other,52.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.98,52.3, "XR HAND MIN 3 VWS LT,LEFT",73130,HCPCS,320,RC,LT,,,both,304.52,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.98,65.65, "XR HAND 2 VIEW LEFT,LEFT",73120,HCPCS,320,RC,LT,,,both,432.48,302.74,,,,,,,,,,,,,,,,,,,Other,93.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,28.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,28.97,93.25, "XR HAND 3 VWS RT,RIGHT",73130,HCPCS,320,RC,RT,,,both,304.52,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.98,65.65, "XR FINGER LEFT THUMB,LT HAND THUMB",73140,HCPCS,320,RC,FA,,,both,304.52,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.06,65.65, "XR HAND 2 VIEW RIGHT,RIGHT",73120,HCPCS,320,RC,RT,,,both,432.48,302.74,,,,,,,,,,,,,,,,,,,Other,93.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,28.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,28.97,93.25, "XR FINGER 2ND DIGIT LEFT,LT HAND 2ND DIGIT",73140,HCPCS,320,RC,F1,,,both,304.52,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.06,65.65, "XR FINGER 3RD DIGIT LEFT,LT HAND 3RD DIGIT",73140,HCPCS,320,RC,F2,,,both,304.52,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.06,65.65, "XR FINGER 4TH DIGIT LEFT,LT HAND 4TH DIGIT",73140,HCPCS,320,RC,F3,,,both,304.52,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.06,65.65, "XR FINGER 5TH DIGIT LEFT,LT HAND 5TH DIGIT",73140,HCPCS,320,RC,F4,,,both,304.52,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.06,65.65, "XR FINGER RIGHT THUMB,RT THUMB",73140,HCPCS,320,RC,F5,,,both,304.52,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.06,65.65, "XR FINGER 2ND DIGIT RIGHT,RT HAND 2ND DIGIT",73140,HCPCS,320,RC,F6,,,both,304.52,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.06,65.65, "XR FINGER 3RD DIGIT RIGHT,RT HAND 3RD DIGIT",73140,HCPCS,320,RC,F7,,,both,304.52,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.06,65.65, "XR FINGER 4TH DIGIT RIGHT,RT HAND 4TH DIGIT",73140,HCPCS,320,RC,F8,,,both,304.52,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.06,65.65, "XR FINGER 5TH DIGIT RIGHT,RT HAND 5TH DIGIT",73140,HCPCS,320,RC,F9,,,both,304.52,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.06,65.65, "XR WRIST LEFT,LEFT",73110,HCPCS,320,RC,LT,,,both,304.51,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,39.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,39.16,65.65, "XR WRIST RIGHT,RIGHT",73110,HCPCS,320,RC,RT,,,both,304.51,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,39.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,39.16,65.65, "XR FEMUR 1V RT,RIGHT",73551,HCPCS,320,RC,RT,,,both,402.24,281.57,,,,,,,,,,,,,,,,,,,Other,86.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.18,86.72, "XR FEMUR 2V RT,RIGHT",73552,HCPCS,320,RC,RT,,,both,402.24,281.57,,,,,,,,,,,,,,,,,,,Other,86.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,32.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,32.92,86.72, "XR FEMUR 1V LT,LEFT",73551,HCPCS,320,RC,LT,,,both,402.24,281.57,,,,,,,,,,,,,,,,,,,Other,86.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.18,86.72, "XR FEMUR 2V LT,LEFT",73552,HCPCS,320,RC,LT,,,both,402.24,281.57,,,,,,,,,,,,,,,,,,,Other,86.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,32.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,32.92,86.72, "CT UPPER EXT WO LT,LEFT",73200,HCPCS,350,RC,LT,,,both,2771.8,1940.26,,,,,,,,,,,,,,,,,,,Other,597.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,148.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,148.24,597.6, "CT UPPER EXT W/ LT,LEFT",73201,HCPCS,350,RC,LT,,,both,2771.8,1940.26,,,,,,,,,,,,,,,,,,,Other,597.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,183.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,183.54,597.6, "CT UPPER EXT W AND WO LT,LEFT",73202,HCPCS,350,RC,LT,,,both,2771.8,1940.26,,,,,,,,,,,,,,,,,,,Other,597.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,225.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,225.56,597.6, "XR FOREARM RIGHT,RIGHT",73090,HCPCS,320,RC,RT,,,both,311.11,217.78,,,,,,,,,,,,,,,,,,,Other,67.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.88,67.07, "XR FOREARM LEFT,LEFT",73090,HCPCS,320,RC,LT,,,both,311.11,217.78,,,,,,,,,,,,,,,,,,,Other,67.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.88,67.07, "XR HUMERUS RIGHT,RIGHT",73060,HCPCS,320,RC,RT,,,both,405.47,283.83,,,,,,,,,,,,,,,,,,,Other,87.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,29.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,29.57,87.42, "XR HUMERUS LEFT,LEFT",73060,HCPCS,320,RC,LT,,,both,405.47,283.83,,,,,,,,,,,,,,,,,,,Other,87.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,29.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,29.57,87.42, "XR SCAPULA COMPLETE RT,RIGHT",73010,HCPCS,320,RC,RT,,,both,427.65,299.36,,,,,,,,,,,,,,,,,,,Other,92.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.32,92.2, "XR SCAPULA COMPLETE LT,LEFT",73010,HCPCS,320,RC,LT,,,both,427.65,299.36,,,,,,,,,,,,,,,,,,,Other,92.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.32,92.2, "XR SCAPULA COMPLETE BIL,BILATERAL PROCEDURE",73010,HCPCS,320,RC,50,,,both,483.39,338.37,,,,,,,,,,,,,,,,,,,Other,104.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,46.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,46.65,104.22, "XR CLAVICLE COMPLETE LT,LEFT",73000,HCPCS,320,RC,LT,,,both,329.81,230.87,,,,,,,,,,,,,,,,,,,Other,71.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.76,71.11, "XR CLAVICLE COMPLETE RT,RIGHT",73000,HCPCS,320,RC,RT,,,both,329.81,230.87,,,,,,,,,,,,,,,,,,,Other,71.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.76,71.11, "XR SHOULDER LEFT 1 VIEW,LEFT",73020,HCPCS,320,RC,LT,,,both,304.51,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.28,65.65, "XR SHOULDER RIGHT 1 VIEW,RIGHT",73020,HCPCS,320,RC,RT,,,both,304.51,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.28,65.65, "XR SHOULDER COMPLETE LT,LEFT",73030,HCPCS,320,RC,LT,,,both,316.95,221.87,,,,,,,,,,,,,,,,,,,Other,68.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,32.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,32.92,68.34, "XR SHOULDER COMPLETE BILATERAL,BILATERAL PROCEDURE",73030,HCPCS,320,RC,50,,,both,483.39,338.37,,,,,,,,,,,,,,,,,,,Other,104.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,65.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.84,104.22, "XR SHOULDER COMPLETE RT,RIGHT",73030,HCPCS,320,RC,RT,,,both,318.12,222.68,,,,,,,,,,,,,,,,,,,Other,68.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,32.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,32.92,68.59, "XR CLAVICLE BILATERAL,BILATERAL PROCEDURE",73000,HCPCS,320,RC,50,,,both,494.71,346.3,,,,,,,,,,,,,,,,,,,Other,106.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,61.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,61.52,106.66, "XR ELBOW 2V BILATERAL,BILATERAL PROCEDURE",73070,HCPCS,320,RC,50,,,both,459.05,321.34,,,,,,,,,,,,,,,,,,,Other,98.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,54.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,54.35,98.97, "XR ELBOW 3V BILATERAL,BILATERAL PROCEDURE",73080,HCPCS,320,RC,50,,,both,619.73,433.81,,,,,,,,,,,,,,,,,,,Other,133.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,61,133.61, "XR FOREARM BILATERAL,BILATERAL PROCEDURE",73090,HCPCS,320,RC,50,,,both,496.66,347.66,,,,,,,,,,,,,,,,,,,Other,107.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,53.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,53.76,107.08, "XR WRIST BILATERAL,BILATERAL PROCEDURE",73110,HCPCS,320,RC,50,,,both,363.86,254.7,,,,,,,,,,,,,,,,,,,Other,78.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,78.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,78.32,78.45, "XR HAND BILATERAL,BILATERAL PROCEDURE",73120,HCPCS,320,RC,50,,,both,376.86,263.8,,,,,,,,,,,,,,,,,,,Other,81.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,57.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,57.94,81.25, "XR TIB/FIB BILATERAL,BILATERAL PROCEDURE",73590,HCPCS,320,RC,50,,,both,608.21,425.75,,,,,,,,,,,,,,,,,,,Other,131.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,57.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,57.94,131.13, "XR ANKLE BILATERAL,BILATERAL PROCEDURE",73610,HCPCS,320,RC,50,,,both,550.2,385.14,,,,,,,,,,,,,,,,,,,Other,118.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,68.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,68.17,118.62, "XR FOOT BILATERAL,BILATERAL PROCEDURE",73630,HCPCS,320,RC,50,,,both,428.4,299.88,,,,,,,,,,,,,,,,,,,Other,92.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,62.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,62.78,92.36, XR AC JOINTS BILATERAL,73050,HCPCS,320,RC,,,,both,435.57,304.9,,,,,,,,,,,,,,,,,,,Other,93.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,28.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,28.14,93.91, "XR TOE LEFT 3RD,LT 3RD TOE",73660,HCPCS,320,RC,T2,,,both,304.51,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.5,65.65, XR NECK SOFT TISSE,70360,HCPCS,320,RC,,,,both,306.32,214.42,,,,,,,,,,,,,,,,,,,Other,66.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,28.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,28.73,66.04, XR TSPINE 2VWS,72070,HCPCS,320,RC,,,,both,432.48,302.74,,,,,,,,,,,,,,,,,,,Other,93.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.59,93.25, XR SACRO ILIAC JNT,72200,HCPCS,320,RC,,,,both,427.65,299.36,,,,,,,,,,,,,,,,,,,Other,92.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,31.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.1,92.2, XR COCCYX AND SACRUM,72220,HCPCS,320,RC,,,,both,331.41,231.99,,,,,,,,,,,,,,,,,,,Other,71.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,29.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,29.6,71.45, XR LUMBR SPINE 4/5VWS,72110,HCPCS,320,RC,,,,both,547.13,382.99,,,,,,,,,,,,,,,,,,,Other,117.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,49.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,49.17,117.96, LUMBAR MYELOGRAM,72265,HCPCS,320,RC,,,,both,2534.36,1774.05,,,,,,,,,,,,,,,,,,,Other,546.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,102.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,102.2,546.41, XR SPINE 1 VIEW,72020,HCPCS,320,RC,,,,both,246.71,172.7,,,,,,,,,,,,,,,,,,,Other,53.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,22.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,22.1,53.19, XR L-SPINE COMPLETE,72114,HCPCS,320,RC,,,,both,590.81,413.57,,,,,,,,,,,,,,,,,,,Other,127.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,56.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,56.75,127.38, XR LUMBAR FLEXION EXTENSION 2V,72120,HCPCS,320,RC,,,,both,417.23,292.06,,,,,,,,,,,,,,,,,,,Other,89.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,38.68,89.95, XR LUMBAR SPINE 2/3VWS,72100,HCPCS,320,RC,,,,both,432.48,302.74,,,,,,,,,,,,,,,,,,,Other,93.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,37.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,37.18,93.25, XR TSPINE 3 VWS,72072,HCPCS,320,RC,,,,both,432.48,302.74,,,,,,,,,,,,,,,,,,,Other,93.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,35.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,35.72,93.25, "XR TOE LEFT 4TH,LEFT 4TH TOE",73660,HCPCS,320,RC,T3,,,both,304.51,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.5,65.65, XR C SPINE 4/5 VWS,72050,HCPCS,320,RC,,,,both,460.08,322.06,,,,,,,,,,,,,,,,,,,Other,99.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,50.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,50.69,99.2, XR C SPINE COMPLETE,72052,HCPCS,320,RC,,,,both,397.05,277.94,,,,,,,,,,,,,,,,,,,Other,85.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,57.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,57.64,85.6, XR C SPINE 2/3 VWS,72040,HCPCS,320,RC,,,,both,386.28,270.4,,,,,,,,,,,,,,,,,,,Other,83.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.58,83.28, XR ELBOW LT 2 VIEWS,73070,HCPCS,320,RC,,,,both,306.03,214.22,,,,,,,,,,,,,,,,,,,Other,65.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.18,65.98, XR ELBOW RT 2 VIEW,73070,HCPCS,320,RC,,,,both,306.03,214.22,,,,,,,,,,,,,,,,,,,Other,65.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.18,65.98, "XR ELBOW RIGHT 3 VIEW,RIGHT",73080,HCPCS,320,RC,RT,,,both,413.15,289.21,,,,,,,,,,,,,,,,,,,Other,89.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.5,89.07, "XR ELBOW LEFT 3 VIEW,LEFT",73080,HCPCS,320,RC,LT,,,both,413.15,289.21,,,,,,,,,,,,,,,,,,,Other,89.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.5,89.07, "XR CALCANEUS RIGHT HEEL,RIGHT",73650,HCPCS,320,RC,RT,,,both,304.51,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.28,65.65, "XR CALCANEUS LEFT HEEL,LEFT",73650,HCPCS,320,RC,LT,,,both,304.51,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.28,65.65, "XR LOWER EXT INFANT LEFT,LEFT",73592,HCPCS,320,RC,LT,,,both,306.03,214.22,,,,,,,,,,,,,,,,,,,Other,65.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,28.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,28.37,65.98, "XR LOWER EXT INFANT RIGHT,RIGHT",73592,HCPCS,320,RC,RT,,,both,306.03,214.22,,,,,,,,,,,,,,,,,,,Other,65.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,28.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,28.37,65.98, XR STERNUM,71120,HCPCS,320,RC,,,,both,329.34,230.54,,,,,,,,,,,,,,,,,,,Other,71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.59,71, XR RIBS BILATERAL MIN 4 VWS,71111,HCPCS,320,RC,,,,both,447.97,313.58,,,,,,,,,,,,,,,,,,,Other,96.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,47.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,47.54,96.58, "XR TOE LEFT 5TH,LT 5TH TOE",73660,HCPCS,320,RC,T4,,,both,304.51,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.5,65.65, "XR RIBS CHEST RIGHT,RIGHT",71101,HCPCS,320,RC,RT,,,both,432.48,302.74,,,,,,,,,,,,,,,,,,,Other,93.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,38.74,93.25, "XR RIBS CHEST LEFT,LEFT",71101,HCPCS,320,RC,LT,,,both,432.48,302.74,,,,,,,,,,,,,,,,,,,Other,93.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,38.74,93.25, XR CHEST 2V PA LAT,71046,HCPCS,324,RC,,,,both,229.01,160.31,,,,,,,,,,,,,,,,,,,Other,49.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.61,49.37, XR CHEST 1 VIEW,71045,HCPCS,324,RC,,,,both,256.6,179.62,,,,,,,,,,,,,,,,,,,Other,55.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.65,55.32, XR CHEST 3VIEWS,71047,HCPCS,324,RC,,,,both,416.58,291.61,,,,,,,,,,,,,,,,,,,Other,89.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,37.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,37.93,89.82, XR CHEST 4+ VWS,71048,HCPCS,324,RC,,,,both,416.58,291.61,,,,,,,,,,,,,,,,,,,Other,89.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,41.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,41.84,89.82, XR FACIAL BONES COMPLETE,70150,HCPCS,320,RC,,,,both,432.38,302.67,,,,,,,,,,,,,,,,,,,Other,93.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,42.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,42.97,93.22, "XR TOE RIGHT GREAT TOE,RT GREAT TOE",73660,HCPCS,320,RC,T5,,,both,304.51,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.5,65.65, XR NASAL BONES COMPLETE,70160,HCPCS,320,RC,,,,both,306.32,214.42,,,,,,,,,,,,,,,,,,,Other,66.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.38,66.04, XR ORBITS,70200,HCPCS,320,RC,,,,both,386.28,270.4,,,,,,,,,,,,,,,,,,,Other,83.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,43.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,43.03,83.28, XR SINUSES COMPLETE,70220,HCPCS,320,RC,,,,both,389.24,272.47,,,,,,,,,,,,,,,,,,,Other,83.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.79,83.92, "XR TOE RIGHT 2ND,RIGHT 2ND TOE",73660,HCPCS,320,RC,T6,,,both,304.51,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.5,65.65, XR MANDIBLE COMPLETE,70110,HCPCS,320,RC,,,,both,386.28,270.4,,,,,,,,,,,,,,,,,,,Other,83.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,39.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,39.66,83.28, XR SKULL LESS THAN 4 VIEWS,70250,HCPCS,320,RC,,,,both,397.05,277.94,,,,,,,,,,,,,,,,,,,Other,85.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,32.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,32.92,85.6, XR SKULL COMPLETE,70260,HCPCS,320,RC,,,,both,432.48,302.74,,,,,,,,,,,,,,,,,,,Other,93.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,40.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,40.35,93.25, "XR TOE RIGHT 3RD,RT 3RD TOE",73660,HCPCS,320,RC,T7,,,both,304.51,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.5,65.65, ANG ABSCESS DRAINAGE FLURO US CT GUIDED,75989,HCPCS,320,RC,,,,both,489.01,342.31,,,,,,,,,,,,,,,,,,,Other,105.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,105.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,105.43,105.93, FL FLUORO TIME 60 MINUTES,76000,HCPCS,320,RC,,,,both,869.49,608.64,,,,,,,,,,,,,,,,,,,Other,187.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,41.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,41.15,187.46, FLUOROGUIDE FOR VEIN DEVICE,77001,HCPCS,320,RC,,,,both,581.57,407.1,,,,,,,,,,,,,,,,,,,Other,125.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,90.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,90.28,125.39, NEEDLE LOCALIZATION BY XRAY,77002,HCPCS,320,RC,,,,both,829.82,580.87,,,,,,,,,,,,,,,,,,,Other,178.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,110.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,110.85,178.91, XR BARIUM SWALLOW,74220,HCPCS,320,RC,,,,both,695.28,486.7,,,,,,,,,,,,,,,,,,,Other,149.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,86.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,86.81,149.9, XR CYSTOGRAM,74430,HCPCS,320,RC,,,,both,1421.44,995.01,,,,,,,,,,,,,,,,,,,Other,306.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,38.88,306.47, UROGRAPHY RETOGRADE,74420,HCPCS,320,RC,,,,both,1456.98,1019.89,,,,,,,,,,,,,,,,,,,Other,314.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,74.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,74.72,314.13, INJECTION RETRO URETHVCYSTGRAM,51610,HCPCS,360,RC,,,,both,247.26,173.08,,,,,,,,,,,,,,,,,,,Other,53.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,120.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,53.31,120.22, DILATION URETHRA - URETERS NEPHROSTOM,74485,HCPCS,320,RC,,,,both,6594.61,4616.23,,,,,,,,,,,,,,,,,,,Other,1421.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.73,1421.79, "XR TOE RIGHT 4TH,RT 4TH TOE",73660,HCPCS,320,RC,T8,,,both,304.51,213.16,,,,,,,,,,,,,,,,,,,Other,65.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.5,65.65, XR CHOLANGIOGRAM INTRAOP,74300,HCPCS,320,RC,,,,both,1302.14,911.5,,,,,,,,,,,,,,,,,,,Other,280.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,280.74,280.74, INTRALUMINAL DILATION ESOPHOGUS,74360,HCPCS,320,RC,,,,both,589.35,412.55,,,,,,,,,,,,,,,,,,,Other,127.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,127.07,127.07, INTRO GI TUBE WITH FLUORO OR FILM,74340,HCPCS,320,RC,,,,both,327.35,229.15,,,,,,,,,,,,,,,,,,,Other,70.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,70.58,70.58, ANG PERCUTANEOUS PLACEMENT GASTRO TUBE,49440,HCPCS,320,RC,,,,both,4173.97,2921.78,,,,,,,,,,,,,,,,,,,Other,899.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,725.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,725.35,899.9, ANG PERCUT PLACEMENT ENTERCLYSIS TUBE,74355,HCPCS,320,RC,,,,both,463.82,324.67,,,,,,,,,,,,,,,,,,,Other,100,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,100,100, XR ACUTE ABD SERIES,74022,HCPCS,320,RC,,,,both,470.99,329.69,,,,,,,,,,,,,,,,,,,Other,101.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,45.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,45.75,101.55, XR ABDOMEN 2 VIEWS,74019,HCPCS,320,RC,,,,both,427.65,299.36,,,,,,,,,,,,,,,,,,,Other,92.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,33.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,33.33,92.2, XR ABDOMEN 3+ VIEWS,74021,HCPCS,320,RC,,,,both,447.38,313.17,,,,,,,,,,,,,,,,,,,Other,96.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,38.82,96.45, XR ABDOMEN 1 VIEW KUB,74018,HCPCS,320,RC,,,,both,354.13,247.89,,,,,,,,,,,,,,,,,,,Other,76.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.54,76.35, "MAMMO DIAGNOSTIC LEFT,LEFT",77065,HCPCS,401,RC,LT,,,both,522.6,365.82,,,,,,,,,,,,,,,,,,,Other,112.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,114.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,112.67,114.4, MAMMO DIAGNOSTIC BILATERAL,77066,HCPCS,401,RC,,,,both,671.46,470.02,,,,,,,,,,,,,,,,,,,Other,144.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,144.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,144.77,144.95, "MAMMO DIAGNOSTIC RIGHT,RIGHT",77065,HCPCS,401,RC,RT,,,both,522.6,365.82,,,,,,,,,,,,,,,,,,,Other,112.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,114.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,112.67,114.4, MAMMO DIAGNOSTIC TOMO,G0279,HCPCS,401,RC,,,,both,161.53,113.07,,,,,,,,,,,,,,,,,,,Other,34.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.83,38.47, MAMMO SCREENING TOMO,77063,HCPCS,403,RC,,,,both,168.92,118.24,,,,,,,,,,,,,,,,,,,Other,36.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,48.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.42,48.04, MAMMO SCREENING BILATERAL W/CAD,77067,HCPCS,403,RC,,,,both,541.6,379.12,,,,,,,,,,,,,,,,,,,Other,81.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,116.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,81.8,116.14, XR UPPER EXT INFANT,73092,HCPCS,320,RC,,,,both,427.65,299.36,,,,,,,,,,,,,,,,,,,Other,92.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,28.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,28.37,92.2, XR SMALL XRAY XM SM INT 1CNTRST STD,74250,HCPCS,320,RC,,,,both,695.17,486.62,,,,,,,,,,,,,,,,,,,Other,149.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,109.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,109.32,149.88, *MAMMO STEREOTACTIC NEEDLE LOC LEFT BRST,19284,HCPCS,360,RC,,,,both,2342.94,1640.06,,,,,,,,,,,,,,,,,,,Other,505.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,167.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,167.71,505.14, MAMMO SURGICAL SPECIMEN,76098,HCPCS,320,RC,,,,both,1837.5,1286.25,,,,,,,,,,,,,,,,,,,Other,396.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,40.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,40.04,396.16, LUNG CYST ASPRI,32555,HCPCS,360,RC,,,,both,1807.14,1265,,,,,,,,,,,,,,,,,,,Other,389.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,289.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,289.21,389.62, DXA BONE DENSITY AXIAL,77080,HCPCS,320,RC,,,,both,376.86,263.8,,,,,,,,,,,,,,,,,,,Other,81.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.26,81.25, ANG UNLISTED FLURO PROCEDURE,76496,HCPCS,320,RC,,,,both,335.53,234.87,,,,,,,,,,,,,,,,,,,Other,72.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,72.34,72.34, MRI CONTRAST GADOL WASTE,A9579,HCPCS,636,RC,,,,both,12.69,8.88,,,,,,,,,,,,,,,,,,,Other,2.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.43,2.73, INTRO PROC BRST BX,19100,HCPCS,360,RC,,,,both,3613.8,2529.66,,,,,,,,,,,,,,,,,,,Other,779.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,156.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,156.06,779.14, BX BREAST 1st LES US GUID,19083,HCPCS,360,RC,,,,both,4628.42,3239.89,,,,,,,,,,,,,,,,,,,Other,997.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,441.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,441.4,997.88, IODINE I-123 SOD IODIDE PER 100 UCI TO 9,A9516,HCPCS,341,RC,,,,both,386.2,270.34,,,,,,,,,,,,,,,,,,,Other,83.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,83.26,83.26, XR JOINT SURVEY SINGLE VIEW 2+ JOINTS,77077,HCPCS,320,RC,,,,both,423.16,296.21,,,,,,,,,,,,,,,,,,,Other,91.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,43.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,43.98,91.24, "SONO BREAST BILATERAL,BILATERAL PROCEDURE",76641,HCPCS,402,RC,50,,,both,954,667.8,,,,,,,,,,,,,,,,,,,Other,205.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,139.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,139.11,205.68, XR NJX CHOLANGIO PRQ W IMG GID RS&I EXIS,47531,HCPCS,320,RC,,,,both,11423.57,7996.5,,,,,,,,,,,,,,,,,,,Other,2462.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,363.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,363.13,2462.93, XR NJX CHOLANGIO PRQ W IMG GID RS&I NEW,47532,HCPCS,320,RC,,,,both,11423.57,7996.5,,,,,,,,,,,,,,,,,,,Other,2462.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,746.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,746.33,2462.93, "SONO BREAST LIMITED BILATERAL,BILATERAL PROCEDURE",76642,HCPCS,402,RC,50,,,both,2021.9,1415.33,,,,,,,,,,,,,,,,,,,Other,435.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,116.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,116.48,435.92, XR CHEST 2V INSP EXP,71046,HCPCS,324,RC,,,,both,216.07,151.25,,,,,,,,,,,,,,,,,,,Other,46.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.61,46.59, "XR CALCANEUS BILATERAL HEEL,BILATERAL PROCEDURE",73650,HCPCS,320,RC,50,,,both,456.77,319.74,,,,,,,,,,,,,,,,,,,Other,98.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,52.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,52.57,98.48, "XR HUMERUS BILATERAL,BILATERAL PROCEDURE",73060,HCPCS,320,RC,50,,,both,591.08,413.76,,,,,,,,,,,,,,,,,,,Other,127.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,29.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,29.57,127.44, FLUOROGUIDE FOR SPINE INJECT,77003,HCPCS,320,RC,,,,both,1610.28,1127.2,,,,,,,,,,,,,,,,,,,Other,347.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,96.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,96.28,347.17, US PREGNANT UTERUS LIMITED 1 > FETUSES,76815,HCPCS,402,RC,,,,both,354.11,247.88,,,,,,,,,,,,,,,,,,,Other,76.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,75.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,75.77,76.34, CONTRAST ISOVUE 300,Q9967,HCPCS,636,RC,,,,both,0.84,0.59,,,,,,,,,,,,,,,,,,,Other,0.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.15,0.18, CONTRAST ISOVUE 300 WASTE,Q9967,HCPCS,636,RC,,,,both,0.82,0.57,,,,,,,,,,,,,,,,,,,Other,0.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.15,0.18, ANG ABDOMINAL AORTOGRPHY,75625,HCPCS,323,RC,,,,both,9771.36,6839.95,,,,,,,,,,,,,,,,,,,Other,2106.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,120.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,120.74,2106.71, ANG THORACTIC AORTOGRAPHY,75605,HCPCS,323,RC,,,,both,16205.89,11344.12,,,,,,,,,,,,,,,,,,,Other,3493.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,114.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,114.33,3493.99, ANG ABDM AORTGRPHY W ROFF,75630,HCPCS,323,RC,,,,both,9771.36,6839.95,,,,,,,,,,,,,,,,,,,Other,2106.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,149.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,149.71,2106.71, ANG PULMONARY ANGIO UNIL,75741,HCPCS,323,RC,,,,both,9771.36,6839.95,,,,,,,,,,,,,,,,,,,Other,2106.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,120.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,120.44,2106.71, ANG HEPATIC VENOGRAM,75889,HCPCS,320,RC,,,,both,9771.36,6839.95,,,,,,,,,,,,,,,,,,,Other,2106.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,114.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,114.45,2106.71, ANG INFERIOR VENACAVGRPH,75825,HCPCS,320,RC,,,,both,9771.36,6839.95,,,,,,,,,,,,,,,,,,,Other,2106.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,107.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,107.75,2106.71, ANG SUPERIOR VENACAVOGRP,75827,HCPCS,320,RC,,,,both,2367.91,1657.54,,,,,,,,,,,,,,,,,,,Other,510.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,112.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,112.74,510.52, ANG SELECTIVE UNILATERAL RENAL,36251,HCPCS,360,RC,,,,both,9638.68,6747.08,,,,,,,,,,,,,,,,,,,Other,2078.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1131.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1131.45,2078.1, SUPER SELECTIVE RENAL UNILATERAL,36253,HCPCS,360,RC,,,,both,16205.89,11344.12,,,,,,,,,,,,,,,,,,,Other,3493.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1736.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1736.78,3493.99, SUPER SELECTIVE RENAL BILATERAL,36254,HCPCS,360,RC,,,,both,9771.36,6839.95,,,,,,,,,,,,,,,,,,,Other,2106.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1767.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1767.57,2106.71, ANG SELECTIV RENAL BILAT,36252,HCPCS,360,RC,,,,both,15353.19,10747.23,,,,,,,,,,,,,,,,,,,Other,3310.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1252.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1252.18,3310.15, ANG EXTREMITY BILATERAL ANGIOGRAPHY,75716,HCPCS,323,RC,,,,both,9771.36,6839.95,,,,,,,,,,,,,,,,,,,Other,2106.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,155.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,155.9,2106.71, ANG EXTREMITY UNILATER ANGIO,75710,HCPCS,323,RC,,,,both,9771.36,6839.95,,,,,,,,,,,,,,,,,,,Other,2106.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,143.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,143.78,2106.71, ANG SELECTIVE VISCERAL,75726,HCPCS,323,RC,,,,both,9771.36,6839.95,,,,,,,,,,,,,,,,,,,Other,2106.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,159.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,159.54,2106.71, ANG ADD SELECTIVE VESSEL ADD ON,75774,HCPCS,323,RC,,,,both,7445.86,5212.1,,,,,,,,,,,,,,,,,,,Other,1605.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,89.67,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,89.67,1605.33, ANG TRANSCATHETER PERCUTANEOUS STENT,37236,HCPCS,360,RC,,,,both,36334.18,25433.93,,,,,,,,,,,,,,,,,,,Other,7833.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2391.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2391.87,7833.65, ANG EMBOLIZATION OR OCCLUSION VEIN,37241,HCPCS,360,RC,,,,both,37242.54,26069.78,,,,,,,,,,,,,,,,,,,Other,8029.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3982.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3982.1,8029.49, ANG TRANSCATHETER EMBOLIZATION,75894,HCPCS,320,RC,,,,both,25103.59,17572.51,,,,,,,,,,,,,,,,,,,Other,5412.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,300.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,300.4,5412.33, ANG VENOGRPHY EXT UNILAT,75820,HCPCS,320,RC,,,,both,2367.91,1657.54,,,,,,,,,,,,,,,,,,,Other,510.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,100.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,100.75,510.52, ANG VENOGRPHY EXTR BILAT,75822,HCPCS,320,RC,,,,both,5751.27,4025.89,,,,,,,,,,,,,,,,,,,Other,1239.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,126.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,126.32,1239.97, ANG RENAL VENOGRAPHY UNILATERAL,75831,HCPCS,320,RC,,,,both,9771.36,6839.95,,,,,,,,,,,,,,,,,,,Other,2106.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,111.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,111.9,2106.71, ANG RENAL VENOGRPHY BIL,75833,HCPCS,320,RC,,,,both,9771.36,6839.95,,,,,,,,,,,,,,,,,,,Other,2106.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,148.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,148.97,2106.71, ANG VENOUS SAMPLING,75893,HCPCS,320,RC,,,,both,16205.89,11344.12,,,,,,,,,,,,,,,,,,,Other,3493.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,102.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,102.14,3493.99, ANG PELVIC SELECTIVE,75736,HCPCS,323,RC,,,,both,9771.36,6839.95,,,,,,,,,,,,,,,,,,,Other,2106.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,133.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,133.71,2106.71, ANG EXTREMITY UNILATERAL,75710,HCPCS,323,RC,,,,both,9771.36,6839.95,,,,,,,,,,,,,,,,,,,Other,2106.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,143.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,143.78,2106.71, ANG ANGIOGRAM EXISNG CATH,75898,HCPCS,320,RC,,,,both,5895.05,4126.54,,,,,,,,,,,,,,,,,,,Other,1270.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,258.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,258.44,1270.97, ANG CATHETER IN CORONARY ARTERY ANGIO,93454,HCPCS,481,RC,,,,both,10299.97,7209.98,,,,,,,,,,,,,,,,,,,Other,2220.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,817.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,817.57,2220.67, ANG ANGIO BYPASS GRAFT,93455,HCPCS,481,RC,,,,both,10299.97,7209.98,,,,,,,,,,,,,,,,,,,Other,2220.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,913.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,913.91,2220.67, ANG LEFT HEART CATH WITH VENTRICLE,93452,HCPCS,481,RC,,,,both,10299.97,7209.98,,,,,,,,,,,,,,,,,,,Other,2220.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,815.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,815.54,2220.67, ANG RIGHT HEART CATH WITH 02,93451,HCPCS,481,RC,,,,both,10299.97,7209.98,,,,,,,,,,,,,,,,,,,Other,2220.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,777.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,777.57,2220.67, ANG NATIVE CORONARY ANGIL W/L+ HEART,93458,HCPCS,481,RC,,,,both,10299.97,7209.98,,,,,,,,,,,,,,,,,,,Other,2220.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,943.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,943.32,2220.67, ANG NATIVE CORONARY AND BYPASS GRAFT,93459,HCPCS,481,RC,,,,both,10299.97,7209.98,,,,,,,,,,,,,,,,,,,Other,2220.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1018.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1018.13,2220.67, ANG SWAN GUNZ CATHETERIZATION,93503,HCPCS,481,RC,,,,both,5895.05,4126.54,,,,,,,,,,,,,,,,,,,Other,1270.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,82.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,82.3,1270.97, ANG CAROTID STENT W PROTECTION,37215,HCPCS,360,RC,,,,both,30346.08,21242.26,,,,,,,,,,,,,,,,,,,Other,6542.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,943.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,943.44,6542.62, ANG CAROTID STENT WOUT PROTECTION,37216,HCPCS,360,RC,,,,both,30346.08,21242.26,,,,,,,,,,,,,,,,,,,Other,6542.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6542.62,6542.62, ANG CATHETER AORTA FEMORAL ACCESS,36200,HCPCS,360,RC,,,,both,7976.01,5583.21,,,,,,,,,,,,,,,,,,,Other,1719.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,527.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,527.73,1719.63, ANG CATHETER EXTREMITY ARTERY,36140,HCPCS,360,RC,,,,both,7976.01,5583.21,,,,,,,,,,,,,,,,,,,Other,1719.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,459.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,459.86,1719.63, ANG ARTERIAL SELECTIVE 1ST ORDER,36215,HCPCS,360,RC,,,,both,8306.86,5814.8,,,,,,,,,,,,,,,,,,,Other,1790.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,976.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,976.92,1790.96, ANG ARTERIAL SELECTIVE 2ND ORDER,36216,HCPCS,360,RC,,,,both,12726.19,8908.33,,,,,,,,,,,,,,,,,,,Other,2743.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1005.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1005.46,2743.76, ANG ARTERIAL SELECTIVE 3RD ORDER,36217,HCPCS,360,RC,,,,both,12726.19,8908.33,,,,,,,,,,,,,,,,,,,Other,2743.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1818.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1818.02,2743.76, ANG ARTERIAL ADDITIONAL 2ND OR 3RD,36218,HCPCS,360,RC,,,,both,12726.19,8908.33,,,,,,,,,,,,,,,,,,,Other,2743.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,212.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,212.87,2743.76, ANG ABDOMEN 1ST ORDER,36245,HCPCS,360,RC,,,,both,12726.19,8908.33,,,,,,,,,,,,,,,,,,,Other,2743.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1103.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1103.77,2743.76, ANG ABDOMEN 2ND ORDER,36246,HCPCS,360,RC,,,,both,12726.19,8908.33,,,,,,,,,,,,,,,,,,,Other,2743.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,750.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,750.22,2743.76, ANG ABDOMEN LOWER EXTREMITY 3RD ORDER,36247,HCPCS,360,RC,,,,both,12726.19,8908.33,,,,,,,,,,,,,,,,,,,Other,2743.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1251.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1251.18,2743.76, ANG ADDITIONAL 1 2 3 ORDER EACH,36248,HCPCS,360,RC,,,,both,12367.52,8657.26,,,,,,,,,,,,,,,,,,,Other,2666.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,105.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,105.76,2666.43, ANG VENA CAVA VENOGRAPHY,36010,HCPCS,360,RC,,,,both,4238.22,2966.75,,,,,,,,,,,,,,,,,,,Other,913.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,473.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,473.22,913.76, ANG CATHETER VEIN 1ST ORDER,36011,HCPCS,360,RC,,,,both,4223.37,2956.36,,,,,,,,,,,,,,,,,,,Other,910.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,719.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,719.81,910.56, ANG CATHETER VEIN 2ND ORDER,36012,HCPCS,360,RC,,,,both,5131.87,3592.31,,,,,,,,,,,,,,,,,,,Other,1106.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,746.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,746.15,1106.43, ANG CATHETER RV OR MAIN PA,36013,HCPCS,360,RC,,,,both,2830.5,1981.35,,,,,,,,,,,,,,,,,,,Other,610.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,709.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,610.26,709.15, ANG SELECT RT OR LT PULMONARY ART,36014,HCPCS,360,RC,,,,both,4255.07,2978.55,,,,,,,,,,,,,,,,,,,Other,917.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,690.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,690.4,917.4, ANG CATHETER SEGMENTAL PULMONARY A,36015,HCPCS,360,RC,,,,both,4359.7,3051.79,,,,,,,,,,,,,,,,,,,Other,939.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,730.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,730.84,939.95, ANG INJECTION EXISTING CATHETER,36598,HCPCS,360,RC,,,,both,1313.72,919.6,,,,,,,,,,,,,,,,,,,Other,283.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,107.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,107.24,283.24, ANG CYSIS CLOTTED CATHETER/DEVICE,36593,HCPCS,360,RC,,,,both,1286.98,900.89,,,,,,,,,,,,,,,,,,,Other,277.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.5,277.48, ANG VENA LAVA FILTER PLACEMENT,37191,HCPCS,360,RC,,,,both,16854.01,11797.81,,,,,,,,,,,,,,,,,,,Other,3633.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1712.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1712.72,3633.72, ANG EMBOLIZATION OCCLUSION ARTERY,37242,HCPCS,360,RC,,,,both,37242.54,26069.78,,,,,,,,,,,,,,,,,,,Other,8029.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6031.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6031.25,8029.49, ANG STENT PLACEMENT VEIN INITIAL,37238,HCPCS,360,RC,,,,both,34674.87,24272.41,,,,,,,,,,,,,,,,,,,Other,7475.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2973.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2973.09,7475.9, ANG STENT VEIN EACH ADDITIONAL,37239,HCPCS,360,RC,,,,both,15339.73,10737.81,,,,,,,,,,,,,,,,,,,Other,3307.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1505.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1505.8,3307.25, ANG PTA AORTA RENAL OR MESENTERIC,37246,HCPCS,360,RC,,,,both,17120.7,11984.49,,,,,,,,,,,,,,,,,,,Other,3691.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1610.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1610.65,3691.22, ANG EMBOLIZATION VEIN,37241,HCPCS,360,RC,,,,both,35541.74,24879.22,,,,,,,,,,,,,,,,,,,Other,7662.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3982.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3982.1,7662.8, ANG EMBOLIZATION HEMMORRHAGE A OR V,37244,HCPCS,360,RC,,,,both,38359.81,26851.87,,,,,,,,,,,,,,,,,,,Other,8270.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5534.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5534.93,8270.38, "PAT-ILIAC A., STRAIGHTFORWARD INITIAL",37254,HCPCS,360,RC,,,,both,19582.56,13707.79,,,,,,,,,,,,,,,,,,,Other,4222,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1911.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1911.54,4222, "PAT-ILIAC A., STRAIGHTFORWARD ADDITIONAL",37255,HCPCS,360,RC,,,,both,9791.3,6853.91,,,,,,,,,,,,,,,,,,,Other,2111.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,479.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,479.99,2111.01, "PAT-ILIAC A., COMPLEX INITIAL",37256,HCPCS,360,RC,,,,both,28688.45,20081.92,,,,,,,,,,,,,,,,,,,Other,6185.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2258.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2258.46,6185.23, "PAT-ILIAC A., COMPLEX EA ADDITIONAL",37257,HCPCS,360,RC,,,,both,14344.24,10040.97,,,,,,,,,,,,,,,,,,,Other,3092.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,549.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,549.16,3092.62, "STENT-ILIAC A, STRAIGHTFORWARD, INITIAL",37258,HCPCS,360,RC,,,,both,39539.42,27677.59,,,,,,,,,,,,,,,,,,,Other,8524.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3256.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3256.64,8524.7, "STENT-ILIAC A, STRAIGHTFORWARD EA ADDTL",37259,HCPCS,360,RC,,,,both,9779.71,6845.8,,,,,,,,,,,,,,,,,,,Other,2108.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1111.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1111.09,2108.51, "STENT-ILIAC A, COMPLEX INITIAL",37260,HCPCS,360,RC,,,,both,57134.48,39994.14,,,,,,,,,,,,,,,,,,,Other,12318.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7646.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7646.38,12318.2, "STENT-ILIAC A, COMPLEX EA ADDTL.",37261,HCPCS,360,RC,,,,both,28567.24,19997.07,,,,,,,,,,,,,,,,,,,Other,6159.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3041.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3041.87,6159.09, "PTA-FEM POP, STRAIGHTFORWARD INITIAL",37263,HCPCS,360,RC,,,,both,19582.56,13707.79,,,,,,,,,,,,,,,,,,,Other,4222,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4919.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4222,4919.13, "PTA-FEM POP, STRAIGHTFORWARD EA ADDTL",37264,HCPCS,360,RC,,,,both,9791.3,6853.91,,,,,,,,,,,,,,,,,,,Other,2111.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1977.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1977.02,2111.01, "PTA-FEM POP, COMPLEX INITIAL",37265,HCPCS,360,RC,,,,both,28688.45,20081.92,,,,,,,,,,,,,,,,,,,Other,6185.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6192.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6185.23,6192.08, "PTA-FEM POP, COMPLEX, EA ADDTL.",37266,HCPCS,360,RC,,,,both,14344.24,10040.97,,,,,,,,,,,,,,,,,,,Other,3092.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2215.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2215.18,3092.62, "STENT-FEM POP, STRAIGHTFORWARD EA ADDTL.",37268,HCPCS,360,RC,,,,both,21066.18,14746.33,,,,,,,,,,,,,,,,,,,Other,4541.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3036,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3036,4541.87, "STENT-FEM POP, COMPLEX INITIAL",37269,HCPCS,360,RC,,,,both,57134.48,39994.14,,,,,,,,,,,,,,,,,,,Other,12318.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10454.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10454.38,12318.2, "STENT-FEM POP, COMPLEX EA ADDTL.",37270,HCPCS,360,RC,,,,both,28567.24,19997.07,,,,,,,,,,,,,,,,,,,Other,6159.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3167.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3167.55,6159.09, "PTA-TIB-PERON,STRAIGHTFORWARD,INITIAL",37280,HCPCS,360,RC,,,,both,19582.56,13707.79,,,,,,,,,,,,,,,,,,,Other,4222,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2490.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2490.28,4222, "PTA-TIB-PERON,STRAIGHTFORWARD EA ADDTL.",37281,HCPCS,360,RC,,,,both,9797.3,6858.11,,,,,,,,,,,,,,,,,,,Other,2112.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,681.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,681.26,2112.3, "PTA-TIB-PERON, COMPLEX INITIAL",37282,HCPCS,360,RC,,,,both,28688.45,20081.92,,,,,,,,,,,,,,,,,,,Other,6185.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5553.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5553.18,6185.23, "PTA-TIB-PERON, COMPLEX, EA ADDTL.",37283,HCPCS,360,RC,,,,both,14344.24,10040.97,,,,,,,,,,,,,,,,,,,Other,3092.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,804.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,804.58,3092.62, "STENT-TIB-PERON, STRAIGHTFORWARD INITIAL",37284,HCPCS,360,RC,,,,both,39539.42,27677.59,,,,,,,,,,,,,,,,,,,Other,8524.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5115.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5115.75,8524.7, "STENT-TIB-PERON, STRAIGHTFORWARD EA ADDT",37285,HCPCS,360,RC,,,,both,19769.71,13838.8,,,,,,,,,,,,,,,,,,,Other,4262.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2519.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2519.55,4262.35, "STENT-FEM POP, STRAIGHTFORWARD INITIAL",37267,HCPCS,360,RC,,,,both,57134.48,39994.14,,,,,,,,,,,,,,,,,,,Other,12318.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4729.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4729.68,12318.2, "STENT-TIB-PERON, COMPLEX EA ADDTL.",37287,HCPCS,360,RC,,,,both,28567.24,19997.07,,,,,,,,,,,,,,,,,,,Other,6159.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4458.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4458.37,6159.09, "PTA-FOOT ARTERY, STRIGHTFORWARD INITIAL",37296,HCPCS,360,RC,,,,both,18170.86,12719.6,,,,,,,,,,,,,,,,,,,Other,3917.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2799.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2799.87,3917.64, "PTA-FOOT ARTERY, STRIGHTFORWARD EA ADDTL",37297,HCPCS,360,RC,,,,both,12069.15,8448.41,,,,,,,,,,,,,,,,,,,Other,2602.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,771.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,771.27,2602.11, "PTA-FOOT ARTERY, COMPLEX INITIAL",37298,HCPCS,360,RC,,,,both,26771.16,18739.81,,,,,,,,,,,,,,,,,,,Other,5771.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3155.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3155.47,5771.87, "PTA-FOOT ARTERY, COMPLEX EA ADDTL.",37299,HCPCS,360,RC,,,,both,26771.16,18739.81,,,,,,,,,,,,,,,,,,,Other,5771.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,840.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,840.92,5771.87, "STENT-TIB-PERON, COMPLEX INITIAL",37286,HCPCS,360,RC,,,,both,52684.56,36879.19,,,,,,,,,,,,,,,,,,,Other,11358.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9378.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9378.49,11358.79, INJECTION PX PRQ TX EXTREMITY PSEUDOANEU,36002,HCPCS,360,RC,,,,both,1983.41,1388.39,,,,,,,,,,,,,,,,,,,Other,427.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,147.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,147.21,427.62, ANG THORACIC AORTA WITH CAROTID AN,36221,HCPCS,360,RC,,,,both,9771.36,6839.95,,,,,,,,,,,,,,,,,,,Other,2106.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,882.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,882.65,2106.71, ANG CCA SELECTIVE WITH CAROTID ANG,36222,HCPCS,360,RC,,,,both,9771.36,6839.95,,,,,,,,,,,,,,,,,,,Other,2106.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1169.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1169.5,2106.71, ANG CCA SELECTIVE WITH CEREBRAL,36223,HCPCS,360,RC,,,,both,16205.89,11344.12,,,,,,,,,,,,,,,,,,,Other,3493.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1766.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1766.27,3493.99, ANG ICA SELECTIVE,36224,HCPCS,360,RC,,,,both,16205.89,11344.12,,,,,,,,,,,,,,,,,,,Other,3493.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2162.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2162.06,3493.99, ANG SUBCLAVIAN/INNOMIWATE W VERT,36225,HCPCS,360,RC,,,,both,9771.36,6839.95,,,,,,,,,,,,,,,,,,,Other,2106.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1655.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1655.57,2106.71, ANG VERTEBRAL ARTERY SELECTIVE,36226,HCPCS,360,RC,,,,both,16205.89,11344.12,,,,,,,,,,,,,,,,,,,Other,3493.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2103.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2103.53,3493.99, ANG ECA SELECTIVE ADD ON,36227,HCPCS,360,RC,,,,both,13404.93,9383.45,,,,,,,,,,,,,,,,,,,Other,2890.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,264.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,264.39,2890.1, ANG ICA/VERTEBRAL BRANCH SELECTIVE,36228,HCPCS,360,RC,,,,both,10480.81,7336.57,,,,,,,,,,,,,,,,,,,Other,2259.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1421.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1421.12,2259.66, ANG CATHETER EXCHANGE ART/VEIN,37213,HCPCS,360,RC,,,,both,8166.32,5716.42,,,,,,,,,,,,,,,,,,,Other,1760.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,212.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,212.38,1760.66, ANG ARTERIAL INFUSION LYSIS INITIAL,37211,HCPCS,360,RC,,,,both,16611.03,11627.72,,,,,,,,,,,,,,,,,,,Other,3581.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,356.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,356.18,3581.34, ANG VENOUS INFUSION LYSIS INITIAL,37212,HCPCS,360,RC,,,,both,10015.65,7010.96,,,,,,,,,,,,,,,,,,,Other,2159.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,308.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,308.24,2159.37, ANG CESSATION OF THROMBOLYSIS,37214,HCPCS,360,RC,,,,both,8166.32,5716.42,,,,,,,,,,,,,,,,,,,Other,1760.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,112.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,112.85,1760.66, ANG INTRO CATH DIALYSIS CIRCUIT,36903,HCPCS,321,RC,,,,both,34936.71,24455.7,,,,,,,,,,,,,,,,,,,Other,7532.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4336.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4336.54,7532.36, ANG AVF GRAFT DIAGNOSTIC ANGIO,36901,HCPCS,321,RC,,,,both,5687.8,3981.46,,,,,,,,,,,,,,,,,,,Other,1226.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,634.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,634.33,1226.29, ANG PTA AVF GRAFT,36902,HCPCS,321,RC,,,,both,17467.19,12227.03,,,,,,,,,,,,,,,,,,,Other,3765.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1094.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1094.14,3765.92, ENDOVENOUSE MCHNCHEM 1ST VEIN,36473,HCPCS,360,RC,,,,both,9771.36,6839.95,,,,,,,,,,,,,,,,,,,Other,2106.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1076.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1076.13,2106.71, ENDOVENOUS MCHNCHEM ADD ON,36474,HCPCS,360,RC,,,,both,4387.78,3071.45,,,,,,,,,,,,,,,,,,,Other,946,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,228.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,228.12,946, ANG PTA VEIN INITIAL OR SAME,37248,HCPCS,360,RC,,,,both,16232.38,11362.67,,,,,,,,,,,,,,,,,,,Other,3499.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1204.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1204.36,3499.7, "ANG CCA SELECTIVE WITH CAROTID ANG BILAT,BILATERAL PROCEDURE",36222,HCPCS,360,RC,50,,,both,15023.47,10516.43,,,,,,,,,,,,,,,,,,,Other,3239.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1754.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1754.26,3239.06, ANG CATHETER IN CORONARY ARTERY ANGIO BI,93454,HCPCS,481,RC,,,,both,15449.95,10814.97,,,,,,,,,,,,,,,,,,,Other,3331.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,817.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,817.57,3331.01, "ANG BILAT CCA SELECTIVE W CEREBRAL,BILATERAL PROCEDURE",36223,HCPCS,360,RC,50,,,both,24308.84,17016.19,,,,,,,,,,,,,,,,,,,Other,5240.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2649.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2649.41,5240.98, INJECTION PROCEDURE SHOULDER ARTHR,23350,HCPCS,360,RC,,,,both,724.57,507.2,,,,,,,,,,,,,,,,,,,Other,156.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,145.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,145.17,156.22, INJECTION PROCEDURE FOR WRIST ARTHOGRAPH,25246,HCPCS,360,RC,,,,both,493.05,345.14,,,,,,,,,,,,,,,,,,,Other,106.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,174.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,106.3,174.95, ILIAC ART ANGIO CARDIAC CATH,G0278,HCPCS,360,RC,,,,both,2008.39,1405.87,,,,,,,,,,,,,,,,,,,Other,433.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.42,433.01, OPEN FEM ART EXPOSURE,34812,HCPCS,360,RC,,,,both,20137.53,14096.27,,,,,,,,,,,,,,,,,,,Other,4341.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,199.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,199.17,4341.65, EVASC RPR ILIO ILIAC ENDOGRAFT,34707,HCPCS,360,RC,,,,both,25056.15,17539.31,,,,,,,,,,,,,,,,,,,Other,5402.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1117.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1117.57,5402.1, ANGIOSCOPY NONCORONARY VESSEL GRAFTS TH,35400,HCPCS,360,RC,,,,both,2100,1470,,,,,,,,,,,,,,,,,,,Other,452.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,141.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,141.45,452.76, ANG EXTREMITY VENOGRAPHY,36005,HCPCS,360,RC,,,,both,4238.22,2966.75,,,,,,,,,,,,,,,,,,,Other,913.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,224.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,224.81,913.76, "ANG VERTEBRAL ARTERY SELECTIVE,BILATERAL PROCEDURE",36226,HCPCS,360,RC,50,,,both,24308.84,17016.19,,,,,,,,,,,,,,,,,,,Other,5240.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3155.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3155.3,5240.98, "ANG ABDOMEN/LOWER EXTREMITY 3RD ORDER BI,BILATERAL PROCEDURE",36247,HCPCS,360,RC,50,,,both,17820.29,12474.2,,,,,,,,,,,,,,,,,,,Other,3842.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1876.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1876.77,3842.05, CT 3D RECONSTRUCTION,76376,HCPCS,350,RC,,,,both,1493.55,1045.49,,,,,,,,,,,,,,,,,,,Other,322.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.71,322.01, CT CORONARY CALCIUM SCORING SCREEN,75571,HCPCS,350,RC,,,,both,150,105,,,,,,,,,,,,,,,,,,,Other,32.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,91.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,32.34,91.75, "CT UPPER EXT W RT,RIGHT",73201,HCPCS,350,RC,RT,,,both,2852.2,1996.54,,,,,,,,,,,,,,,,,,,Other,614.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,183.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,183.54,614.93, CT MAXILLOFACIAL WO/W IV CONTRAST,70488,HCPCS,350,RC,,,,both,3153.29,2207.3,,,,,,,,,,,,,,,,,,,Other,679.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,170.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,170.11,679.85, CT MAXILLOFACIAL WO IV CONTRAST,70486,HCPCS,350,RC,,,,both,1278.1,894.67,,,,,,,,,,,,,,,,,,,Other,275.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,118.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,118.4,275.56, CT HEAD WO IV CONTRAST,70450,HCPCS,351,RC,,,,both,2342.99,1640.09,,,,,,,,,,,,,,,,,,,Other,505.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,98.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,98.97,505.15, CT HEAD WITH IV CONTRAST,70460,HCPCS,351,RC,,,,both,2735.11,1914.58,,,,,,,,,,,,,,,,,,,Other,589.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,137.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,137.74,589.69, CT HEAD WWO IV CONTRAST,70470,HCPCS,351,RC,,,,both,3080.62,2156.43,,,,,,,,,,,,,,,,,,,Other,664.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,160.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,160.25,664.19, CT ST NECK WO IV CONTRAST,70490,HCPCS,350,RC,,,,both,2409.53,1686.67,,,,,,,,,,,,,,,,,,,Other,519.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,139.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,139.15,519.5, CT ST NECK WITH IV CONTRAST,70491,HCPCS,350,RC,,,,both,2811.47,1968.03,,,,,,,,,,,,,,,,,,,Other,606.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,169.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,169.82,606.15, CTA ABDOMEN PELVIS,74174,HCPCS,350,RC,,,,both,4260.15,2982.11,,,,,,,,,,,,,,,,,,,Other,918.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,348.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,348.34,918.49, CT ST NECK WOW IV CONTRAST,70492,HCPCS,350,RC,,,,both,3165.59,2215.91,,,,,,,,,,,,,,,,,,,Other,682.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,203.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,203.27,682.5, CTA PELVIS,72191,HCPCS,350,RC,,,,both,3669.93,2568.95,,,,,,,,,,,,,,,,,,,Other,791.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,279.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,279.95,791.23, CTA AORTO ILIAC RUNOFF,75635,HCPCS,350,RC,,,,both,5440.56,3808.39,,,,,,,,,,,,,,,,,,,Other,1172.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,378.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,378.81,1172.98, CTA ABDOMEN,74175,HCPCS,350,RC,,,,both,3669.93,2568.95,,,,,,,,,,,,,,,,,,,Other,791.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,280.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,280.27,791.23, CTA HEAD,70496,HCPCS,350,RC,,,,both,3079.7,2155.79,,,,,,,,,,,,,,,,,,,Other,663.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,252.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,252.48,663.98, CTA NECK,70498,HCPCS,350,RC,,,,both,3669.93,2568.95,,,,,,,,,,,,,,,,,,,Other,791.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,252.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,252.48,791.23, CTA CHEST,71275,HCPCS,350,RC,,,,both,3669.93,2568.95,,,,,,,,,,,,,,,,,,,Other,791.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,259.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,259.05,791.23, CT CHEST WO IV CONTRAST,71250,HCPCS,350,RC,,,,both,2564.47,1795.13,,,,,,,,,,,,,,,,,,,Other,552.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,123.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,123.13,552.9, CT LUNG SCREEN DIAGNOSTIC,71250,HCPCS,350,RC,,,,both,2564.47,1795.13,,,,,,,,,,,,,,,,,,,Other,552.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,123.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,123.13,552.9, CTA HRT W 3D IMAGE,75574,HCPCS,350,RC,,,,both,3685.27,2579.69,,,,,,,,,,,,,,,,,,,Other,794.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,301.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,301.45,794.54, CT CHEST WITH IV CONTRAST,71260,HCPCS,350,RC,,,,both,2961.68,2073.18,,,,,,,,,,,,,,,,,,,Other,638.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,154.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,154.26,638.54, CT CHEST WO/W IV CONTRAST,71270,HCPCS,350,RC,,,,both,3315.8,2321.06,,,,,,,,,,,,,,,,,,,Other,714.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,180.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,180.52,714.89, CT PELVIS WO IV CONTRAST,72192,HCPCS,350,RC,,,,both,2564.47,1795.13,,,,,,,,,,,,,,,,,,,Other,552.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,123.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,123.16,552.9, CT PELVIS WITH IV CONTRAST,72193,HCPCS,350,RC,,,,both,2889.44,2022.61,,,,,,,,,,,,,,,,,,,Other,622.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,207.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,207.15,622.97, CT PELVIS WWO IV CONTRAST,72194,HCPCS,350,RC,,,,both,3316.71,2321.7,,,,,,,,,,,,,,,,,,,Other,715.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,229.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,229.44,715.09, CT ABDOMEN WO IV CONTRAST,74150,HCPCS,350,RC,,,,both,2564.47,1795.13,,,,,,,,,,,,,,,,,,,Other,552.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,126.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,126.94,552.9, CT ABDOMEN WITH IV CONTRAST,74160,HCPCS,350,RC,,,,both,2889.44,2022.61,,,,,,,,,,,,,,,,,,,Other,622.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,211.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,211.36,622.97, CT ABDOMEN/PELVIS WO CONTRAST,74176,HCPCS,350,RC,,,,both,3795.91,2657.14,,,,,,,,,,,,,,,,,,,Other,818.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,170.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,170.95,818.4, CT ABDOMEN/PELVIS WITH IV CONTRAST,74177,HCPCS,350,RC,,,,both,4378.19,3064.73,,,,,,,,,,,,,,,,,,,Other,943.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,276.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,276.48,943.94, CT ABDOMEN/PELVIS WWO IV CONTRAST,74178,HCPCS,350,RC,,,,both,4732.31,3312.62,,,,,,,,,,,,,,,,,,,Other,1020.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,311.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,311.21,1020.29, CT ABDOMEN WO/W IV CONTRAST,74170,HCPCS,350,RC,,,,both,3315.8,2321.06,,,,,,,,,,,,,,,,,,,Other,714.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,237.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,237.42,714.89, CT C SPINE WO CONTRAST,72125,HCPCS,350,RC,,,,both,2599.58,1819.71,,,,,,,,,,,,,,,,,,,Other,560.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,121.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,121.13,560.47, CT C SPINE W CONTRAST,72126,HCPCS,350,RC,,,,both,2719.35,1903.55,,,,,,,,,,,,,,,,,,,Other,586.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,155.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,155.93,586.29, CT C SPINE WO/W CONTRAST,72127,HCPCS,350,RC,,,,both,2719.35,1903.55,,,,,,,,,,,,,,,,,,,Other,586.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,180.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,180.87,586.29, CT T SPINE WO,72128,HCPCS,350,RC,,,,both,2564.47,1795.13,,,,,,,,,,,,,,,,,,,Other,552.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,120.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,120.83,552.9, CT T SPINE W,72129,HCPCS,350,RC,,,,both,2719.35,1903.55,,,,,,,,,,,,,,,,,,,Other,586.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,156.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,156.82,586.29, CT L SPINE WO CONTRAST,72131,HCPCS,350,RC,,,,both,2564.47,1795.13,,,,,,,,,,,,,,,,,,,Other,552.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,120.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,120.53,552.9, CT T SPINE W AND WO,72130,HCPCS,350,RC,,,,both,2719.35,1903.55,,,,,,,,,,,,,,,,,,,Other,586.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,182.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,182.66,586.29, CT L SPINE W CONTRAST,72132,HCPCS,350,RC,,,,both,1301.44,911.01,,,,,,,,,,,,,,,,,,,Other,280.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,156.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,156.22,280.59, CT L SPINE W AND WO,72133,HCPCS,350,RC,,,,both,2719.35,1903.55,,,,,,,,,,,,,,,,,,,Other,586.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,181.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,181.47,586.29, CT GUIDANCE FOR NEEDLE PLACEMENT,77012,HCPCS,350,RC,,,,both,2700.81,1890.57,,,,,,,,,,,,,,,,,,,Other,582.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,116.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,116.27,582.3, CT GUIDED NEEDLE PLACEMENT BX ASP,77012,HCPCS,350,RC,,,,both,2511.71,1758.2,,,,,,,,,,,,,,,,,,,Other,541.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,116.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,116.27,541.53, CT IAC ORB SELLA WO IV CONTRAST,70480,HCPCS,350,RC,,,,both,2069.6,1448.72,,,,,,,,,,,,,,,,,,,Other,446.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,147.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,147.13,446.2, "CT UPP EXT WO RIGHT,RIGHT",73200,HCPCS,350,RC,RT,,,both,2451.14,1715.8,,,,,,,,,,,,,,,,,,,Other,528.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,148.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,148.24,528.46, CT MAXILLOFACIAL WITH IV CONTRAST,70487,HCPCS,350,RC,,,,both,2799.15,1959.41,,,,,,,,,,,,,,,,,,,Other,603.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,140.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,140.73,603.49, "CT UPPER EXTREMITY W AND WO RT,RIGHT",73202,HCPCS,350,RC,RT,,,both,1632.53,1142.77,,,,,,,,,,,,,,,,,,,Other,351.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,225.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,225.56,351.98, "CT LOWER EXT WO IV CONT RIGHT,RIGHT",73700,HCPCS,350,RC,RT,,,both,2451.14,1715.8,,,,,,,,,,,,,,,,,,,Other,528.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,120.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,120.83,528.46, "CT LOWER EXT WO IV CONTRAST LEFT,LEFT",73700,HCPCS,350,RC,LT,,,both,2451.14,1715.8,,,,,,,,,,,,,,,,,,,Other,528.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,120.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,120.83,528.46, "CT LOWER EXT WO IV CONTRAST BILATERAL,BILATERAL PROCEDURE",73700,HCPCS,350,RC,50,,,both,2544.99,1781.49,,,,,,,,,,,,,,,,,,,Other,548.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,241.67,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,241.67,548.7, "CT LOWER EXT WITH IV CONTRAST BILATERAL,BILATERAL PROCEDURE",73701,HCPCS,350,RC,50,,,both,1523.33,1066.33,,,,,,,,,,,,,,,,,,,Other,328.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,307.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,307.33,328.43, "CT LOWER EXT WITH IV CONTRAST RIGHT,RIGHT",73701,HCPCS,350,RC,RT,,,both,2851.89,1996.32,,,,,,,,,,,,,,,,,,,Other,614.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,153.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,153.66,614.87, "CT LOWER EXT WITH IV CONTRAST LEFT,LEFT",73701,HCPCS,350,RC,LT,,,both,2851.89,1996.32,,,,,,,,,,,,,,,,,,,Other,614.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,153.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,153.66,614.87, "CT LOWER EXT WOW IV CONTRAST BILTERAL,BILATERAL PROCEDURE",73702,HCPCS,350,RC,50,,,both,2889.97,2022.98,,,,,,,,,,,,,,,,,,,Other,623.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,359.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,359.07,623.07, "CT LOWER EXT WOW IV CONTRAST RIGHT,RIGHT",73702,HCPCS,350,RC,RT,,,both,2958.14,2070.7,,,,,,,,,,,,,,,,,,,Other,637.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,179.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,179.54,637.77, "CT LOWER EXT WOW IV CONTRAST LEFT,LEFT",73702,HCPCS,350,RC,LT,,,both,2958.14,2070.7,,,,,,,,,,,,,,,,,,,Other,637.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,179.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,179.54,637.77, SONO BLADDER SCAN,76775,HCPCS,402,RC,,,,both,1238.3,866.81,,,,,,,,,,,,,,,,,,,Other,266.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,56.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,56.87,266.98, VL ANKLE/BRACHIAL INDEX (ABI/TBI),93922,HCPCS,921,RC,,,,both,1005.1,703.57,,,,,,,,,,,,,,,,,,,Other,216.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,76.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,76.17,216.7, VL SEGMENTAL ARTERY PRESSURES,93923,HCPCS,921,RC,,,,both,1404.15,982.91,,,,,,,,,,,,,,,,,,,Other,302.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,122.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,122.71,302.73, VL TOE PRESSURES,93923,HCPCS,921,RC,,,,both,1404.15,982.91,,,,,,,,,,,,,,,,,,,Other,302.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,122.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,122.71,302.73, VL FINGER PRESSURES,93923,HCPCS,921,RC,,,,both,1404.15,982.91,,,,,,,,,,,,,,,,,,,Other,302.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,122.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,122.71,302.73, VL ABI WITH EXERCISE,93924,HCPCS,921,RC,,,,both,1478.94,1035.26,,,,,,,,,,,,,,,,,,,Other,318.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,151.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,151.24,318.86, VL THORACIC OUTLET EVAL,93923,HCPCS,921,RC,,,,both,1404.15,982.91,,,,,,,,,,,,,,,,,,,Other,302.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,122.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,122.71,302.73, "VL CAROTID DUPLEX BILATERAL,TECHNICAL COMPONENT",93880,HCPCS,921,RC,TC,,,both,1655.2,1158.64,,,,,,,,,,,,,,,,,,,Other,356.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.32,356.86, "VL CAROTID DUPLEX RIGHT,RIGHT",93882,HCPCS,921,RC,RT,,,both,1103,772.1,,,,,,,,,,,,,,,,,,,Other,237.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.97,237.81, VL CAROTID DUPLEX LIMITED,93882,HCPCS,921,RC,,,,both,1103,772.1,,,,,,,,,,,,,,,,,,,Other,237.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.97,237.81, VL TEMPORAL ARTERY DUPLEX,93882,HCPCS,921,RC,,,,both,1103,772.1,,,,,,,,,,,,,,,,,,,Other,237.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.97,237.81, VL ARTERIAL DUPLEX ARM BILATERAL,93930,HCPCS,921,RC,,,,both,1619.74,1133.82,,,,,,,,,,,,,,,,,,,Other,349.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,182.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,182.16,349.21, "VL ARTERIAL DUPLEX RIGHT ARM,RIGHT",93931,HCPCS,921,RC,RT,,,both,1182.34,827.64,,,,,,,,,,,,,,,,,,,Other,254.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,111.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,111.07,254.91, "VL ARTERIAL DUPLEX LEFT ARM,LEFT",93931,HCPCS,921,RC,LT,,,both,1182.34,827.64,,,,,,,,,,,,,,,,,,,Other,254.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,111.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,111.07,254.91, VL ARTERIAL DUPLEX LEG BILATERAL,93925,HCPCS,921,RC,,,,both,1938.34,1356.84,,,,,,,,,,,,,,,,,,,Other,417.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,217.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,217.04,417.9, "VL ARTERIAL DUPLEX RIGHT LEG,RIGHT",93926,HCPCS,921,RC,RT,,,both,1334.96,934.47,,,,,,,,,,,,,,,,,,,Other,287.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,128.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,128.31,287.82, "VL ARTERIAL DUPLEX LEFT LEG,LEFT",93926,HCPCS,921,RC,LT,,,both,1334.96,934.47,,,,,,,,,,,,,,,,,,,Other,287.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,128.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,128.31,287.82, VL MESENTERIC ART DPLX,93975,HCPCS,921,RC,,,,both,1961.74,1373.22,,,,,,,,,,,,,,,,,,,Other,422.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,237.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,237.9,422.95, VL RENAL ARTERY DUPLEX COMPLETE,93975,HCPCS,921,RC,,,,both,1961.74,1373.22,,,,,,,,,,,,,,,,,,,Other,422.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,237.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,237.9,422.95, VL ABDOMINAL VENOUS DUPLEX,93975,HCPCS,921,RC,,,,both,1961.74,1373.22,,,,,,,,,,,,,,,,,,,Other,422.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,237.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,237.9,422.95, VL RENAL ARTERY DUPLEX LIMITED,93976,HCPCS,921,RC,,,,both,1533.37,1073.36,,,,,,,,,,,,,,,,,,,Other,330.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,143.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,143.28,330.59, "VL AA ILIAC DUPLEX,TECHNICAL COMPONENT",93978,HCPCS,921,RC,TC,,,both,1451,1015.7,,,,,,,,,,,,,,,,,,,Other,312.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,128.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,128.55,312.84, VL RENAL BYPASS GRAFT DUPLEX,93978,HCPCS,921,RC,,,,both,1504.37,1053.06,,,,,,,,,,,,,,,,,,,Other,324.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,166.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,166.58,324.34, VL AA ILIAC DUPLEX LTD,93979,HCPCS,921,RC,,,,both,1065.53,745.87,,,,,,,,,,,,,,,,,,,Other,229.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,107.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,107.4,229.73, "VL BYPASS GRAFT RIGHT LEG,RIGHT",93926,HCPCS,921,RC,RT,,,both,1334.96,934.47,,,,,,,,,,,,,,,,,,,Other,287.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,128.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,128.31,287.82, "VL BYPASS GRAFT LEFT LEG,LEFT",93926,HCPCS,921,RC,LT,,,both,1334.96,934.47,,,,,,,,,,,,,,,,,,,Other,287.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,128.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,128.31,287.82, VL DEEP VEIN DUPLEX BIL. LEG,93970,HCPCS,921,RC,,,,both,1853.6,1297.52,,,,,,,,,,,,,,,,,,,Other,399.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,168.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,168.52,399.63, "VL DEEP VEIN DUPLEX RIGHT LEG,RIGHT",93971,HCPCS,921,RC,RT,,,both,1228,859.6,,,,,,,,,,,,,,,,,,,Other,264.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,106.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,106.32,264.76, "VL DEEP VEIN DUPLEX LEFT LEG,LEFT",93971,HCPCS,921,RC,LT,,,both,1228,859.6,,,,,,,,,,,,,,,,,,,Other,264.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,106.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,106.32,264.76, VL DEEP VEIN DUPLEX BIL. ARM,93970,HCPCS,921,RC,,,,both,1853.6,1297.52,,,,,,,,,,,,,,,,,,,Other,399.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,168.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,168.52,399.63, "VL DEEP VEIN DUPLEX RIGHT ARM,RIGHT",93971,HCPCS,921,RC,RT,,,both,1228,859.6,,,,,,,,,,,,,,,,,,,Other,264.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,106.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,106.32,264.76, "VL DEEP VEIN DUPLEX LEFT ARM,LEFT",93971,HCPCS,921,RC,LT,,,both,1228,859.6,,,,,,,,,,,,,,,,,,,Other,264.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,106.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,106.32,264.76, VL VENOUS REFLUX DUPLEX,93970,HCPCS,921,RC,,,,both,2199.84,1539.89,,,,,,,,,,,,,,,,,,,Other,474.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,168.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,168.52,474.28, VL VEIN MAPPING COMPLETE,93970,HCPCS,921,RC,,,,both,2199.84,1539.89,,,,,,,,,,,,,,,,,,,Other,474.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,168.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,168.52,474.28, VL VEIN MAPPING LIMITED,93971,HCPCS,921,RC,,,,both,1378.71,965.1,,,,,,,,,,,,,,,,,,,Other,297.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,106.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,106.32,297.25, VL DIALYSIS ACCESS DUPLEX,93990,HCPCS,921,RC,,,,both,1246.44,872.51,,,,,,,,,,,,,,,,,,,Other,268.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,132.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,132.62,268.74, VL US GUIDED VASCULAR ACCESS,76937,HCPCS,402,RC,,,,both,723,506.1,,,,,,,,,,,,,,,,,,,Other,155.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,37.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,37.84,155.88, VL VIDEO OR CD COPY OF PATIENT EXAM,921,RC,,,,,,both,15.75,11.03,,,,,,,,,,,,,,,,,,,Other,3.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.4,3.4, ECHO TEE IMAGING,93312,HCPCS,480,RC,,,,both,3234,2263.8,,,,,,,,,,,,,,,,,,,Other,697.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,222.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,222.78,697.25, ECHO DOPPLER COLOR FLOW MAPPING ADD ON,93325,HCPCS,480,RC,,,,both,471.47,330.03,,,,,,,,,,,,,,,,,,,Other,101.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,21.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,21.41,101.65, "ECHO LIMITED STUDY CONGENITAL DEFECT,TECHNICAL COMPONENT",93303,HCPCS,480,RC,TC,,,both,452.75,316.93,,,,,,,,,,,,,,,,,,,Other,97.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,144.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,97.62,144.09, ADULT ECHO COMPLETE W/O CONTRAST,93306,HCPCS,480,RC,,,,both,3586.69,2510.68,,,,,,,,,,,,,,,,,,,Other,773.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,181.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,181.77,773.29, ECHO DOBUTAMINE STRESS ECHOCARDIOGRAM,93350,HCPCS,480,RC,,,,both,4357.55,3050.29,,,,,,,,,,,,,,,,,,,Other,939.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,171.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,171.39,939.49, ECHO TREADMILL STRESS ECHOCARDIOGRAM,93350,HCPCS,480,RC,,,,both,2131,1491.7,,,,,,,,,,,,,,,,,,,Other,459.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,171.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,171.39,459.44, ADULT ECHO COMPLETE WITH CONTRAST,C8929,HCPCS,480,RC,,,,both,3240.74,2268.52,,,,,,,,,,,,,,,,,,,Other,698.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,698.7,698.7, ECHO 2D TEE W OR WO FOL W CONT INTERP,C8925,HCPCS,480,RC,,,,both,2440.7,1708.49,,,,,,,,,,,,,,,,,,,Other,526.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,526.21,526.21, ADULT ECHO W CONTRAST W/STRESS,C8928,HCPCS,480,RC,,,,both,3397.02,2377.91,,,,,,,,,,,,,,,,,,,Other,732.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,732.39,732.39, "DEFINITY INJ, PERFLUTREN LIPID MICROSPHE",Q9957,HCPCS,254,RC,,,,both,505.59,353.91,,,,,,,,,,,,,,,,,,,Other,109.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,39.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,39.41,109.01, DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL,93985,HCPCS,921,RC,,,,both,2715.71,1901,,,,,,,,,,,,,,,,,,,Other,585.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,228.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,228.78,585.51, DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL,93986,HCPCS,921,RC,,,,both,1195.56,836.89,,,,,,,,,,,,,,,,,,,Other,257.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,136.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.21,257.76, "DEFINITY INJ, PERFLUTREN LIPID MICROS ML",Q9957,HCPCS,254,RC,,,,both,505.59,353.91,,,,,,,,,,,,,,,,,,,Other,109.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,39.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,39.41,109.01, US PV RESIDUAL URINE BLDR SCAN,51798,HCPCS,761,RC,,,,both,207.92,145.54,,,,,,,,,,,,,,,,,,,Other,44.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.78,44.83, ADULT ECHO LIMITED WITH CONTRAST,C8924,HCPCS,480,RC,,,,both,1839.64,1287.75,,,,,,,,,,,,,,,,,,,Other,396.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,396.63,396.63, MRI BRAIN /+CONT,70553,HCPCS,611,RC,,,,both,2781.59,1947.11,,,,,,,,,,,,,,,,,,,Other,599.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,293.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,293.36,599.71, MRA/MRV NECK W WO CONTRAST,70549,HCPCS,615,RC,,,,both,3817.59,2672.31,,,,,,,,,,,,,,,,,,,Other,823.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,315,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,315,823.07, CT Lung Cancer Screening,71271,HCPCS,350,RC,,,,both,520.77,364.54,,,,,,,,,,,,,,,,,,,Other,112.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,126.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,112.28,126.63, CT CHEST HIGH RESOLUTION,71250,HCPCS,350,RC,,,,both,2564.47,1795.13,,,,,,,,,,,,,,,,,,,Other,552.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,123.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,123.13,552.9, MMRA ABDOMEN WO CONTRAST,C8901,HCPCS,610,RC,,,,both,3283.74,2298.62,,,,,,,,,,,,,,,,,,,Other,707.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,707.97,707.97, DIAGNOSTIC CHEST LDLS,71250,HCPCS,350,RC,,,,both,2564.47,1795.13,,,,,,,,,,,,,,,,,,,Other,552.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,123.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,123.13,552.9, "XR ANKLE LT 1-2V,LEFT",73600,HCPCS,320,RC,LT,,,both,366.49,256.54,,,,,,,,,,,,,,,,,,,Other,79.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,29.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,29.87,79.02, "XR ANKLE RT 1-2V,RIGHT",73600,HCPCS,320,RC,RT,,,both,367.08,256.96,,,,,,,,,,,,,,,,,,,Other,79.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,29.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,29.87,79.14, "MRI WRIST JT LEFT WO CONTRAST,LEFT",73221,HCPCS,610,RC,LT,,,both,3613.48,2529.44,,,,,,,,,,,,,,,,,,,Other,779.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,189.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,189.17,779.07, "MRI WRIST JT RIGHT WO CONTRAST,RIGHT",73221,HCPCS,610,RC,RT,,,both,3613.48,2529.44,,,,,,,,,,,,,,,,,,,Other,779.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,189.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,189.17,779.07, "MMRI WRIST JT RIGHT WO/W CONTRAST,RIGHT",73223,HCPCS,610,RC,RT,,,both,4311.04,3017.73,,,,,,,,,,,,,,,,,,,Other,929.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,351.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,351.96,929.46, "MMRI WRIST JT LEFT WO/W CONTRAST,LEFT",73223,HCPCS,610,RC,LT,,,both,3961.82,2773.27,,,,,,,,,,,,,,,,,,,Other,854.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,351.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,351.96,854.17, XR BABYGRAM,76010,HCPCS,320,RC,,,,both,283.34,198.34,,,,,,,,,,,,,,,,,,,Other,61.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.64,61.08, "XR RIBS LEFT,LEFT",71100,HCPCS,320,RC,LT,,,both,290.42,203.29,,,,,,,,,,,,,,,,,,,Other,62.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,33.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,33.3,62.61, "XR RIBS RIGHT,RIGHT",71100,HCPCS,320,RC,RT,,,both,290.42,203.29,,,,,,,,,,,,,,,,,,,Other,62.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,33.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,33.3,62.61, Adult Echo with contrast,C8929,HCPCS,480,RC,,,,both,4131,2891.7,,,,,,,,,,,,,,,,,,,Other,890.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,890.64,890.64, ADULT ECHO LIMITED W/OUT CONTRAST,93308,HCPCS,480,RC,,,,both,1198.62,839.03,,,,,,,,,,,,,,,,,,,Other,258.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,92.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,92.88,258.43, ADULT ECHO LIMITED WITH CONTRAST,C8924,HCPCS,480,RC,,,,both,1839.64,1287.75,,,,,,,,,,,,,,,,,,,Other,396.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,396.63,396.63, "ADULT ECHO W/OUT CONTRAST W/STRESS,PROFESSIONAL COMPONENT",93350,HCPCS,480,RC,26,,,both,1705.13,1193.59,,,,,,,,,,,,,,,,,,,Other,367.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,65.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.47,367.63, BENZONATATE 100MG CAP (TESSALON),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FAMCICLOVIR 500MG TAB (FAMVIR),637,RC,,,,1,ME,both,31.81,22.27,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, HYOSCYAMINE 0.375MG TAB (LEVBID),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ROPIVACAINE 1% 10MG/ML 10ML INJ (NAROPIN,J2795,HCPCS,636,RC,,1,ME,both,31.81,22.27,,,,,,,,,,,,,,,,,,,Other,6.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.05,6.86, guaiFENesin DM 20mg/200MG 10ML(ROBITUSSI,637,RC,,,,1,ME,both,6.31,4.42,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, TRACE ELEMENTS INJ 1ML,250,RC,,,,1,ML,both,145.46,101.82,,,,,,,,,,,,,,,,,,,Other,31.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,31.36,31.36, ESTRADIOL 0.5MG TAB (ESTRACE),J1380,HCPCS,250,RC,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,1.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.57,7.11, LISINOPRIL 10MG TAB (ZESTRIL),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, SPIRONOLACTONE 25MG TAB (ALDACTONE),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ENOXAPARIN SQ 150MG/ML (LOVENOX),J1650,HCPCS,250,RC,,1,ME,both,346.33,242.43,,,,,,,,,,,,,,,,,,,Other,74.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.52,74.67, AMITRIPTYLINE 25MG TAB (ELAVIL),J1320,HCPCS,637,RC,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, SODIUM CHLORIDE 1000MG TAB,637,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, AMPICILLIN 500MG CAP,J0290,HCPCS,250,RC,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,1.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.58,1.7, ALUMINUM HYDROXIDE 320MG/5ML GEL 120ML,637,RC,,,,1,ME,both,20.33,14.23,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CEFADROXIL 500MG CAP (DURICEF),637,RC,,,,1,ME,both,19.36,13.55,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, SERTRALINE 50MG TAB (ZOLOFT),637,RC,,,,1,ME,both,11.06,7.74,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NITROPRUSSIDE 50MG/2ML INJ (NITROPRESS),250,RC,,,,1,ME,both,5495.06,3846.54,,,,,,,,,,,,,,,,,,,Other,1184.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1184.73,1184.73, ADRIAMYCIN INJ 10MG/5ML,J9000,HCPCS,636,RC,,1,ME,both,113.66,79.56,,,,,,,,,,,,,,,,,,,Other,24.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.72,24.51, LANSOPRAZOLE 30MG SOLUTAB (PREVACID),250,RC,,,,1,ME,both,53.37,37.36,,,,,,,,,,,,,,,,,,,Other,11.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.51,11.51, PALONOSETRON 0.25MG/5ML (ALOXI),J2469,HCPCS,636,RC,,1,ME,both,2177.33,1524.13,,,,,,,,,,,,,,,,,,,Other,469.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.34,469.43, PEGFILGASTRIM (NEULASTA),J2505,HCPCS,636,RC,,1,ML,both,20552.18,14386.53,,,,,,,,,,,,,,,,,,,Other,4431.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2177.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2177.2,4431.05, WARFARIN 2.5MG TAB (COUMADIN),250,RC,,,,1,ME,both,6.68,4.68,,,,,,,,,,,,,,,,,,,Other,1.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.44,1.44, NEO/POLY/HC OTIC SUSP(CORTISPORIN OTIC),250,RC,,,,1,EA,both,468.02,327.61,,,,,,,,,,,,,,,,,,,Other,100.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,100.9,100.9, DIVALPROEX DR 250MG TAB (DEPAKOTE),250,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,1.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.57,1.57, RU TUSS TAB,A9270,HCPCS,250,RC,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,1.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.7,1.7, VERAPAMIL SR 180MG TAB (ISOPTIN SR),J8499,HCPCS,637,RC,,1,ME,both,11.02,7.71,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FENTANYL 500MCG/10ML INJ (SUBLIMAZE),J3010,HCPCS,636,RC,,1,ME,both,27.9,19.53,,,,,,,,,,,,,,,,,,,Other,6.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.17,6.02, SULFASALAZINE DR 500MG TAB (SULFAZINE),J8499,HCPCS,637,RC,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, IBUPROFEN 600MG TAB (MOTRIN),250,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,1.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.57,1.57, STERILE WATER INJ 10ML,250,RC,,,,1,ML,both,18.19,12.73,,,,,,,,,,,,,,,,,,,Other,3.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.92,3.92, FLUMAZENIL 0.5MG/5ML INJ (ROMAZICON),250,RC,,,,1,ME,both,47.64,33.35,,,,,,,,,,,,,,,,,,,Other,10.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.27,10.27, CARB/LEVO 25/250MG TAB (SINEMET),J8499,HCPCS,250,RC,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,1.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.7,1.7, SILVER SULFADIAZINE 1%CREAM 50GM (SILVAD,A6250,HCPCS,250,RC,,1,EA,both,69.15,48.41,,,,,,,,,,,,,,,,,,,Other,14.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.91,14.91, D10W 10% 1000ML IV FLUID,J7042,HCPCS,258,RC,,1,ML,both,37.89,26.52,,,,,,,,,,,,,,,,,,,Other,8.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.28,8.17, A & D OINT 60GM,A6250,HCPCS,250,RC,,1,GM,both,24.4,17.08,,,,,,,,,,,,,,,,,,,Other,5.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.26,5.26, "HEPARIN SOD/0.45%NS 25,000U/250ML PREMIX",J1644,HCPCS,636,RC,,1,ML,both,61.02,42.71,,,,,,,,,,,,,,,,,,,Other,13.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.18,13.15, D5W 5% 100ML IV FLUID,J7060,HCPCS,636,RC,,1,ML,both,35.15,24.61,,,,,,,,,,,,,,,,,,,Other,7.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.72,7.58, DEXTROSE INJ 5% 250ML,J7060,HCPCS,258,RC,,1,ML,both,30.8,21.56,,,,,,,,,,,,,,,,,,,Other,6.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.72,6.64, D5W 5% 500ML IV FLUID,J7060,HCPCS,636,RC,,1,ML,both,30.8,21.56,,,,,,,,,,,,,,,,,,,Other,6.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.72,6.64, D5W/0.45% NS 1000ML IV FLUID,J7042,HCPCS,636,RC,,1,ML,both,36.61,25.63,,,,,,,,,,,,,,,,,,,Other,7.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.28,7.89, D5W/0.9%NS 1000ML IV FLUID,258,RC,,,,1,ML,both,34.84,24.39,,,,,,,,,,,,,,,,,,,Other,7.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.51,7.51, D5W/LR 1000ML IV FLUID,J7121,HCPCS,258,RC,,1,ML,both,40.66,28.46,,,,,,,,,,,,,,,,,,,Other,8.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.77,8.77, LACTATED RINGER 1000ML IV FLUID,J7120,HCPCS,258,RC,,1,ML,both,36.51,25.56,,,,,,,,,,,,,,,,,,,Other,7.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.33,7.87, NACL 0.45% 1000ML IV FLUID,J7030,HCPCS,258,RC,,1,ML,both,33.74,23.62,,,,,,,,,,,,,,,,,,,Other,7.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.95,7.27, NACL 0.9% 100ML IV FLUID,J7050,HCPCS,258,RC,,1,ML,both,30.42,21.29,,,,,,,,,,,,,,,,,,,Other,6.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.65,6.56, NACL 0.9% IV 250ML IV FLUID,J7050,HCPCS,258,RC,,1,ML,both,43.58,30.51,,,,,,,,,,,,,,,,,,,Other,9.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.65,9.4, NACL 0.9% 100ML IV MINI BAG,J7050,HCPCS,258,RC,,1,ML,both,45.5,31.85,,,,,,,,,,,,,,,,,,,Other,9.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.65,9.81, NACL 0.9% IV 500ML IV FLUID,J7040,HCPCS,636,RC,,1,ML,both,30.8,21.56,,,,,,,,,,,,,,,,,,,Other,6.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.26,6.64, NACL 0.9% 1000ML IV FLUID,J7030,HCPCS,258,RC,,1,ML,both,32.25,22.58,,,,,,,,,,,,,,,,,,,Other,6.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.95,6.96, STERILE WATER IRRIG 500ML,258,RC,,,,1,ML,both,39.27,27.49,,,,,,,,,,,,,,,,,,,Other,8.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.47,8.47, D 50W 50% 500ML,B4164,HCPCS,250,RC,,1,ML,both,90.43,63.3,,,,,,,,,,,,,,,,,,,Other,19.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.49,19.49, SODIUM CHLOR SOL 0.9% 1000ML,J7131,HCPCS,258,RC,,1,ML,both,91.81,64.27,,,,,,,,,,,,,,,,,,,Other,19.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.8,19.8, SODIUM CHLORIDE 100MEQ/40ML INJ,J7131,HCPCS,250,RC,,1,ML,both,44.94,31.46,,,,,,,,,,,,,,,,,,,Other,9.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.69,9.69, SELENIUM AC INJ 40MCG/ML 10ML,J3490,HCPCS,250,RC,,1,ME,both,35.15,24.61,,,,,,,,,,,,,,,,,,,Other,7.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.58,7.58, POTASSIUM PHOSPHATE 3MM/ML 15ML INJ,J3475,HCPCS,250,RC,,1,ME,both,236.18,165.33,,,,,,,,,,,,,,,,,,,Other,50.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.39,50.92, POTASSIUM ACETATE 40MEQ/20ML 20ML INJ,J3490,HCPCS,250,RC,,1,ME,both,33.46,23.42,,,,,,,,,,,,,,,,,,,Other,7.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.21,7.21, FINASTERIDE 5MG TAB (PROSCAR),S0138,HCPCS,250,RC,,1,ME,both,13.44,9.41,,,,,,,,,,,,,,,,,,,Other,2.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.9,2.9, THIAMINE HCL 200MG/2ML INJ,J3411,HCPCS,636,RC,,1,ME,both,50.85,35.6,,,,,,,,,,,,,,,,,,,Other,10.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.77,10.97, SODIUM CHLORIDE SOL 0.9% 3000ML,J3490,HCPCS,258,RC,,1,ML,both,36.61,25.63,,,,,,,,,,,,,,,,,,,Other,7.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.89,7.89, D5W/0.225% NS 1000ML IV FLUID,J7042,HCPCS,636,RC,,1,ML,both,36.61,25.63,,,,,,,,,,,,,,,,,,,Other,7.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.28,7.89, D5W 5% 1000ML IV FLUID,J7070,HCPCS,636,RC,,1,ML,both,33.41,23.39,,,,,,,,,,,,,,,,,,,Other,7.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.88,7.2, EUCERIN 120GM CRM,A6250,HCPCS,250,RC,,1,GM,both,35.45,24.82,,,,,,,,,,,,,,,,,,,Other,7.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.64,7.64, MEGESTROL ORAL SUSP 40MG/ML 240ML (MEGAC,S0179,HCPCS,637,RC,,1,ME,both,258.59,181.01,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, GENTAMICIN 80MG/2ML INJ,J1580,HCPCS,636,RC,,1,ME,both,35.15,24.61,,,,,,,,,,,,,,,,,,,Other,7.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.13,7.58, ETOMIDATE 2MG/ML 20ML INJ (AMIDATE),J3490,HCPCS,250,RC,,1,ME,both,137.17,96.02,,,,,,,,,,,,,,,,,,,Other,29.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,29.58,29.58, DESMOPRESSIN 4MCG/ML 10ML MDV INJ (DDAVP,J2597,HCPCS,636,RC,,1,ME,both,3066.93,2146.85,,,,,,,,,,,,,,,,,,,Other,661.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.34,661.23, DESMOPRESSIN 0.01% NASAL SPRAY (DDAVP),J2597,HCPCS,250,RC,,1,EA,both,1058.88,741.22,,,,,,,,,,,,,,,,,,,Other,228.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.34,228.29, PSEUDOEPHEDRINE 30MG TAB (SUDAFED),S5000,HCPCS,637,RC,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PIPERACILLIN/TAZOBACTAM 3GM/.375GM INJ,J2543,HCPCS,636,RC,,1,GM,both,73.65,51.56,,,,,,,,,,,,,,,,,,,Other,15.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.07,15.88, NACL 0.9% 20ML INJ,A4218,HCPCS,250,RC,,1,ML,both,9.44,6.61,,,,,,,,,,,,,,,,,,,Other,2.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.04,2.04, ETHYL CHLOR AER,J7665,HCPCS,250,RC,,1,EA,both,56.94,39.86,,,,,,,,,,,,,,,,,,,Other,12.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.28,12.28, ESMOLOL 100MG/10ML INJ (BREVIBLOC),J1805,HCPCS,636,RC,,1,ME,both,86,60.2,,,,,,,,,,,,,,,,,,,Other,18.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.21,18.54, LEVOTHYROXINE 0.075MG TAB (SYNTHROID),J8499,HCPCS,637,RC,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, LIDOCAINE 2000MG/250ML PREMIX (XYLOCAINE,J2003,HCPCS,636,RC,,1,ME,both,103.72,72.6,,,,,,,,,,,,,,,,,,,Other,22.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.36,22.36, MYCOLOG 30GR CRM (NYSTATIN/TRIAMCIN),S5001,HCPCS,250,RC,,1,GM,both,164.09,114.86,,,,,,,,,,,,,,,,,,,Other,35.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.38,35.38, DEXTROSE 50% SYRINGE 25GM/50ML,B4164,HCPCS,250,RC,,1,GM,both,94.42,66.09,,,,,,,,,,,,,,,,,,,Other,20.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.35,20.35, XYLOCAINE HCL INJ 4%,J2003,HCPCS,250,RC,,1,ML,both,41.25,28.88,,,,,,,,,,,,,,,,,,,Other,8.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.9,8.9, CHARCOAL AQUA ACTIDOSE 50GM,S5001,HCPCS,250,RC,,1,GM,both,27.6,19.32,,,,,,,,,,,,,,,,,,,Other,5.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.95,5.95, LEVOTHYROXINE 0.05MG TAB (SYNTHROID),J8499,HCPCS,637,RC,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DAKINS FULL STR 1000ML,A6260,HCPCS,250,RC,,1,ME,both,33.74,23.62,,,,,,,,,,,,,,,,,,,Other,7.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.27,7.27, SOLU MDRL INJ 250MG,J2919,HCPCS,636,RC,,1,ME,both,122.23,85.56,,,,,,,,,,,,,,,,,,,Other,26.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.25,26.35, LIDOCAINE/PRILOCAINE 2.5-2.5% CRM 5GM,A4736,HCPCS,250,RC,,1,EA,both,42.64,29.85,,,,,,,,,,,,,,,,,,,Other,9.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.19,9.19, GENTAMICIN OPTH SOL 0.3% 5ML (GENTAK),S5001,HCPCS,250,RC,,1,EA,both,184.26,128.98,,,,,,,,,,,,,,,,,,,Other,39.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.73,39.73, SODIUM BICARB 8.4 % INJ 50ML VIAL,J3490,HCPCS,250,RC,,1,ML,both,128.17,89.72,,,,,,,,,,,,,,,,,,,Other,27.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,27.64,27.64, BENZOCAINE SPRY 0.5ML (HURRICAINE),A4736,HCPCS,250,RC,,1,ML,both,169.21,118.45,,,,,,,,,,,,,,,,,,,Other,36.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.49,36.49, CECLOR SUSP 250/5ML,J3490,HCPCS,250,RC,,1,ME,both,152.82,106.97,,,,,,,,,,,,,,,,,,,Other,32.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.95,32.95, ALBUTEROL 2MG/5ML 5ML SYRUP,J7613,HCPCS,250,RC,,1,ME,both,41.54,29.08,,,,,,,,,,,,,,,,,,,Other,8.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.07,8.96, SSD CRM 1%,250,RC,,,,1,EA,both,271.95,190.37,,,,,,,,,,,,,,,,,,,Other,58.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,58.63,58.63, PROPRANOLOL 10MG TAB (INDERAL),J8499,HCPCS,637,RC,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, VASOPRESSIN 20U/1ML INJ (PITRESSIN),J2598,HCPCS,250,RC,,1,ME,both,542.34,379.64,,,,,,,,,,,,,,,,,,,Other,116.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.51,116.92, BUPIVACAINE SPINAL 0.75% 2ML AMP (MARCAI,J0665,HCPCS,250,RC,,1,ML,both,33.41,23.39,,,,,,,,,,,,,,,,,,,Other,7.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.01,7.2, LITHIUM CARBONATE CAP 300MG,J8499,HCPCS,637,RC,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CALCIUM ACETATE 667MG CAP (PHOSLO),J8499,HCPCS,637,RC,,1,ME,both,7.22,5.05,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NACL 0.9% IV 50ML IV FLUID,A4217,HCPCS,250,RC,,1,ML,both,23.22,16.25,,,,,,,,,,,,,,,,,,,Other,5.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.01,5.01, THIOPENTAL 500MG INJ (PENTOTHAL),J3490,HCPCS,250,RC,,1,ME,both,84.07,58.85,,,,,,,,,,,,,,,,,,,Other,18.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.13,18.13, ARTIFICIAL TEARS OPHTH SOLN,250,RC,,,,1,EA,both,34.1,23.87,,,,,,,,,,,,,,,,,,,Other,7.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.35,7.35, SODIUM BICARB 8.4% PEDIATRIC ABBOJECT,J3490,HCPCS,250,RC,,1,EA,both,35.45,24.82,,,,,,,,,,,,,,,,,,,Other,7.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.64,7.64, GARAMYCIN OINT 0.1% 15GM,J1580,HCPCS,250,RC,,1,GM,both,27.6,19.32,,,,,,,,,,,,,,,,,,,Other,5.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.13,5.95, SILVER NITRATE STICK,J8499,HCPCS,250,RC,,1,EA,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,1.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.57,1.57, INJ SULFAMETH/TRIM 5 MG/1 MG,J2865,HCPCS,636,RC,,1,ME,both,44.45,31.12,,,,,,,,,,,,,,,,,,,Other,9.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.04,9.58, DURAGESIC SYSTEM 100MCG,J3010,HCPCS,250,RC,,1,ME,both,162.12,113.48,,,,,,,,,,,,,,,,,,,Other,34.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.17,34.96, SUCCINYLCHOLINE 20MG/ML 10ML INJ (ANECTI,250,RC,,,,1,ME,both,163.71,114.6,,,,,,,,,,,,,,,,,,,Other,35.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.3,35.3, FAMOTIDINE 20MG/2ML INJ,J1308,HCPCS,636,RC,,1,ME,both,6.75,4.73,,,,,,,,,,,,,,,,,,,Other,1.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.01,1.46, DILTIAZEM INJ 25MG/5ML,250,RC,,,,1,ME,both,62.46,43.72,,,,,,,,,,,,,,,,,,,Other,13.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.47,13.47, SODIUM BICARB 8.4% ABBOJECT 50ML,J3490,HCPCS,250,RC,,1,ML,both,81.79,57.25,,,,,,,,,,,,,,,,,,,Other,17.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.63,17.63, NACL 0.9% 250ML ADV,A4216,HCPCS,250,RC,,1,ML,both,42.31,29.62,,,,,,,,,,,,,,,,,,,Other,9.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.12,9.12, D5W 5% 250ML IV FLUID,J7060,HCPCS,636,RC,,1,ML,both,43.58,30.51,,,,,,,,,,,,,,,,,,,Other,9.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.72,9.4, ALLOPURINOL 100MG TAB (ZYLOPRIM),J8499,HCPCS,637,RC,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, LEVOTHYROXINE 0.15MG TAB (SYNTHROID),J8499,HCPCS,250,RC,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,1.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.7,1.7, NEOSTIGMINE 10MG/10ML INJ(PROSTIGMIN),250,RC,,,,1,ME,both,545.29,381.7,,,,,,,,,,,,,,,,,,,Other,117.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,117.56,117.56, SOTALOL 80MG TAB (BETAPACE),J8499,HCPCS,637,RC,,1,ME,both,12.2,8.54,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, MAGNESIUM SU INJ 50%,636,RC,,,,1,EA,both,35.45,24.82,,,,,,,,,,,,,,,,,,,Other,7.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.64,7.64, CAPSAICIN 0.025% CRM,J7336,HCPCS,250,RC,,1,EA,both,42.79,29.95,,,,,,,,,,,,,,,,,,,Other,9.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.35,9.22, LIOTHYRONINE 25MCG TAB,J8499,HCPCS,637,RC,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, INDIGO CARMINE 5ML INJ,J3490,HCPCS,250,RC,,1,ML,both,972.25,680.58,,,,,,,,,,,,,,,,,,,Other,209.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,209.62,209.62, CENTRUM LIQ,S5000,HCPCS,250,RC,,1,EA,both,39.8,27.86,,,,,,,,,,,,,,,,,,,Other,8.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.58,8.58, RACEMIC EPINEPHrine INH SOLN 2.25% 0.5ML,J0169,HCPCS,250,RC,,1,ME,both,56.94,39.86,,,,,,,,,,,,,,,,,,,Other,12.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.35,12.28, PAROXETINE 20MG TAB (PAXIL),J8499,HCPCS,637,RC,,1,ME,both,12.63,8.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, POTASSIUM 20 MEQ/15ML ELIXER,J3480,HCPCS,250,RC,,1,ML,both,97.11,67.98,,,,,,,,,,,,,,,,,,,Other,20.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.12,20.93, ZOLPIDEM 5MG TAB (AMBIEN),S5001,HCPCS,637,RC,,1,ME,both,8.29,5.8,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, SODIUM ACETATE 40MEQ/20ML INJ,J3490,HCPCS,250,RC,,1,ME,both,64.24,44.97,,,,,,,,,,,,,,,,,,,Other,13.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.85,13.85, ONDANSETRON 4MG/2ML INJ (ZOFRAN),J2405,HCPCS,636,RC,,1,ME,both,31.66,22.16,,,,,,,,,,,,,,,,,,,Other,6.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.09,6.83, STERILE WATER 20ML INJ,250,RC,,,,1,ME,both,29.32,20.52,,,,,,,,,,,,,,,,,,,Other,6.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.32,6.32, DILTIAZEM CD 120MG CAP (CARDIZEM),S5001,HCPCS,637,RC,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PHYTONADIONE 10MG/ML INJ (VITAMIN K),J3430,HCPCS,636,RC,,1,ME,both,279.46,195.62,,,,,,,,,,,,,,,,,,,Other,60.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.75,60.25, BUMETANIDE 2.5MG/10ML INJ(BUMEX),J1939,HCPCS,250,RC,,1,ME,both,20.33,14.23,,,,,,,,,,,,,,,,,,,Other,4.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.35,4.38, METHYLPREDNISOLONE 2GM INJ (SOLU-MEDROL),J2919,HCPCS,636,RC,,1,GM,both,247.23,173.06,,,,,,,,,,,,,,,,,,,Other,53.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.25,53.3, METFORMIN 500MG TAB (GLUCOPHAGE),J8499,HCPCS,250,RC,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,1.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.49,1.49, IMIPRAMINE HCL 10MG TAB (TOFRANIL),S5001,HCPCS,250,RC,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,1.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.57,1.57, "HEPARIN 5,000units/ML INJ",J1644,HCPCS,636,RC,,1,UN,both,35.45,24.82,,,,,,,,,,,,,,,,,,,Other,7.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.18,7.64, IPRATROPIUM BROM U/D NEB (ATROVENT),J7644,HCPCS,250,RC,,1,EA,both,11.06,7.74,,,,,,,,,,,,,,,,,,,Other,2.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.39,2.38, OXYMETAZOLINE 0.05% NASAL SPRAY(AFRIN),S0012,HCPCS,637,RC,,1,EA,both,27.9,19.53,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, SIMETHICONE 40MG/0.6ML DROP (GAS-X),S5001,HCPCS,250,RC,,1,ME,both,58.01,40.61,,,,,,,,,,,,,,,,,,,Other,12.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.5,12.5, ALBUTEROL SULF NEB SOL 0.083% 3ML,J7613,HCPCS,250,RC,,1,ML,both,11.09,7.76,,,,,,,,,,,,,,,,,,,Other,2.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.07,2.39, CIPROFLOXACIN 400MG/200ML IVPB(CIPRO),J0744,HCPCS,636,RC,,1,ME,both,122.32,85.62,,,,,,,,,,,,,,,,,,,Other,26.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.96,26.37, CHLOROPROCAINE MPF 3% INJ (NESACAINE),250,RC,,,,1,ME,both,107.45,75.22,,,,,,,,,,,,,,,,,,,Other,23.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.17,23.17, BACITRACIN OINT 30GM TUBE,A6250,HCPCS,270,RC,,1,GM,both,20.33,14.23,,,,,,,,,,,,,,,,,,,Other,4.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.38,4.38, ASPIRIN EC 81MG TAB,J8499,HCPCS,637,RC,,1,ME,both,6.43,4.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DIPRIVAN INJ 10MG/ML,J2704,HCPCS,250,RC,,1,ME,both,88.62,62.03,,,,,,,,,,,,,,,,,,,Other,19.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.09,19.11, SODIUM POLYSTYRENE 15GM/60ML (KAYEXALATE,J0275,HCPCS,250,RC,,1,GM,both,133.3,93.31,,,,,,,,,,,,,,,,,,,Other,28.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28.74,28.74, HYDROXYCHLOROQUINE 200MG TAB (PLAQUENIL),S5001,HCPCS,250,RC,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,1.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.61,1.61, THALLIUM TI 201 THALLOUS CHLORIDE,A9505,HCPCS,343,RC,,1,EA,both,448.89,314.22,,,,,,,,,,,,,,,,,,,Other,96.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,96.78,96.78, CEFTRIAXONE 1000MG INJ (ROCEPHIN),J0696,HCPCS,636,RC,,1,ME,both,213.6,149.52,,,,,,,,,,,,,,,,,,,Other,46.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.45,46.05, NYSTATIN OINT 100MU/GM 30GM TUBE,S5000,HCPCS,637,RC,,1,ME,both,114.38,80.07,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, TERAZOSIN 5MG CAP (HYTRIN),J8499,HCPCS,637,RC,,1,ME,both,8.85,6.2,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, RISPERDONE 1MG TAB (RISPERDAL),J2794,HCPCS,250,RC,,1,ME,both,19.53,13.67,,,,,,,,,,,,,,,,,,,Other,4.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.21,10.96, ALBUTEROL NEB SOLN 0.5%(PFT) 2.5MG/0.5ML,J7611,HCPCS,250,RC,,1,ME,both,7.25,5.08,,,,,,,,,,,,,,,,,,,Other,1.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.25,1.57, ITRACONAZOLE 100MG CAP (SPORANOX),J1835,HCPCS,637,RC,,1,ME,both,35.45,24.82,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CALCITONIN SALMON 200IU/ML 2ML INJ,J0630,HCPCS,636,RC,,1,ME,both,177.54,124.28,,,,,,,,,,,,,,,,,,,Other,38.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,173.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,38.28,173.99, CEFTAZIDIME 1000MG INJ (FORTAZ),J0713,HCPCS,636,RC,,1,ME,both,59.56,41.69,,,,,,,,,,,,,,,,,,,Other,12.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.44,12.84, GABAPENTIN 100MG CAP (NEURONTIN),S5001,HCPCS,637,RC,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FLUOXETINE 10MG CAP,S5000,HCPCS,250,RC,,1,ME,both,11.62,8.13,,,,,,,,,,,,,,,,,,,Other,2.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.51,2.51, ISOSORBIDE MONONITRATE ER 60MG TAB(IMDUR,J8499,HCPCS,637,RC,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CISTRACURIUM 2MG/ML INJ (NIMBEX),J3490,HCPCS,250,RC,,1,ME,both,87.44,61.21,,,,,,,,,,,,,,,,,,,Other,18.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.86,18.86, METHACHOLINE 100MG PWD (PROVOCHOLINE),250,RC,,,,1,ME,both,269.35,188.55,,,,,,,,,,,,,,,,,,,Other,58.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,58.07,58.07, ANASTRAZOLE 1MG TAB (ARIMIDEX),S0170,HCPCS,250,RC,,1,ME,both,31.81,22.27,,,,,,,,,,,,,,,,,,,Other,6.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.86,6.86, GLIPIZIDE XL 5MG TAB (GLUCOTROL XL),S5001,HCPCS,250,RC,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,1.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.49,1.49, CHROMAGEN FORTE CAP,S5001,HCPCS,250,RC,,1,EA,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,1.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.7,1.7, DEMEROL CARPUJECT 100MG,J2175,HCPCS,636,RC,,1,ME,both,35.45,24.82,,,,,,,,,,,,,,,,,,,Other,7.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.64,7.99, FLUTICASONE HFA 220MCG MDI (FLOVENT),J3535,HCPCS,636,RC,,1,EA,both,2171.31,1519.92,,,,,,,,,,,,,,,,,,,Other,468.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,468.14,468.14, FLUTICASONE HFA 110MCG MDI (FLOVENT),J3535,HCPCS,250,RC,,1,EA,both,1397.91,978.54,,,,,,,,,,,,,,,,,,,Other,301.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,301.39,301.39, LORAZEPAM 2MG/1ML INJ (ATIVAN),J2060,HCPCS,636,RC,,1,ME,both,51.13,35.79,,,,,,,,,,,,,,,,,,,Other,11.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.38,11.02, CETIRIZINE 10MG TAB (ZYRTEC),J8499,HCPCS,637,RC,,1,ME,both,8.85,6.2,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, "BACITRACIN INJ 50,000 UNITS",A6250,HCPCS,250,RC,,1,ME,both,61.88,43.32,,,,,,,,,,,,,,,,,,,Other,13.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.34,13.34, BOTOX INJ 100 UNITS,J0585,HCPCS,636,RC,,1,UN,both,3384.96,2369.47,,,,,,,,,,,,,,,,,,,Other,729.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.38,729.8, METHYLPREDNISOLONE 4MG TAB (MEDROL),J7509,HCPCS,636,RC,,1,ME,both,148.95,104.27,,,,,,,,,,,,,,,,,,,Other,32.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.14,32.11, AMOXICILLIN/CLAVULANATE 875/125MG TAB,G9315,HCPCS,637,RC,,1,ME,both,22.95,16.07,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, LATANOPROST EYE DROP 0.005% 2.5ML (XALAT,S5001,HCPCS,637,RC,,1,EA,both,178.97,125.28,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, REMIFENTANIL 1MG/3ML INJ (ULTIVA),J3490,HCPCS,250,RC,,1,ME,both,256.43,179.5,,,,,,,,,,,,,,,,,,,Other,55.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,55.28,55.28, MELATONIN 3MG TAB,J8499,HCPCS,250,RC,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,1.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.61,1.61, VITAMIN E 400U CAP,A9153,HCPCS,637,RC,,1,UN,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DALTEPARIN 2500U/0.2ML INJ,J1645,HCPCS,636,RC,,1,UN,both,72.64,50.85,,,,,,,,,,,,,,,,,,,Other,15.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.6,15.66, SILVER SULFADIAZINE CRE 1% 400 GRAM,A6250,HCPCS,250,RC,,1,GM,both,135.96,95.17,,,,,,,,,,,,,,,,,,,Other,29.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,29.31,29.31, DALTEPARIN 5000U/0.2ML INJ,J1645,HCPCS,636,RC,,1,UN,both,197.74,138.42,,,,,,,,,,,,,,,,,,,Other,42.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.6,42.63, AZITHROMYCIN 200MG/5ML 15ML SUSP,Q0144,HCPCS,636,RC,,1,ME,both,149.98,104.99,,,,,,,,,,,,,,,,,,,Other,32.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.34,32.34, ATROPINE SULF 0.4MG/ML INJ,J0461,HCPCS,636,RC,,1,ME,both,33.41,23.39,,,,,,,,,,,,,,,,,,,Other,7.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.1,7.2, MULTI VITAMIN TAB,A9153,HCPCS,637,RC,,1,EA,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, SUMATRIPTAN 6MG/0.5ML INJ (IMITREX),J3030,HCPCS,636,RC,,1,ME,both,376.1,263.27,,,,,,,,,,,,,,,,,,,Other,81.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.09,81.09, SYNTHROID TAB 175MCG,J8499,HCPCS,250,RC,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,1.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.7,1.7, ADENOSINE 6MG/2ML INJ (ADENOCARD),J0153,HCPCS,636,RC,,1,ME,both,54.34,38.04,,,,,,,,,,,,,,,,,,,Other,11.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.52,11.71, WARFARIN 3MG TAB (COUMADIN),J8499,HCPCS,637,RC,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, IBUTILIDE INJ 1MG/10ML INJ (CORVERT),J1742,HCPCS,636,RC,,1,ME,both,934.1,653.87,,,,,,,,,,,,,,,,,,,Other,201.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,200.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,200.96,201.39, LEVOFLOXACIN 500MG TAB (LEVAQUIN),J8499,HCPCS,637,RC,,1,ME,both,72.33,50.63,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, SULFACETAMIDE 10% OPHTH SOLN 15ML,250,RC,,,,1,EA,both,262.3,183.61,,,,,,,,,,,,,,,,,,,Other,56.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,56.56,56.56, NALOXONE HCL 0.4MG/ML INJ (NARCAN),J2312,HCPCS,636,RC,,1,ME,both,88.32,61.82,,,,,,,,,,,,,,,,,,,Other,19.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.06,19.04, DIBUCAINE 1% OINT (NUPERCAINAL),250,RC,,,,1,EA,both,26.45,18.52,,,,,,,,,,,,,,,,,,,Other,5.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.7,5.7, ORPHENADRINE 100MG TAB (NORFLEX),637,RC,,,,1,ME,both,9.92,6.94,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PROPRANOLOL LA 60MG CAP (INDERAL LA),637,RC,,,,1,ME,both,9.11,6.38,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, BUPROPION SR 150MG TAB (WELLBUTRIN SR),637,RC,,,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, LEVOBUNOLOL OPTH SOL 0.5% (BETAGAN),250,RC,,,,1,EA,both,83.97,58.78,,,,,,,,,,,,,,,,,,,Other,18.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.1,18.1, MAGNESIUM OXIDE 400MG TAB (MAG OX),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, SUMATRIPTAN 100MG TAB (IMITREX),250,RC,,,,1,ME,both,116.85,81.8,,,,,,,,,,,,,,,,,,,Other,25.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.2,25.2, NEO/POLY/DEX SUSP 0.1%,250,RC,,,,1,EA,both,42.71,29.9,,,,,,,,,,,,,,,,,,,Other,9.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.21,9.21, SSD CREAM 1% 50 GRAM,250,RC,,,,1,GM,both,39.8,27.86,,,,,,,,,,,,,,,,,,,Other,8.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.58,8.58, AMIODARONE 150MG/3ML (50MG/ML)(CORDARONE,J0282,HCPCS,636,RC,,1,ME,both,67.99,47.59,,,,,,,,,,,,,,,,,,,Other,14.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.4,14.66, MIDAZOLAM 5MG/5ML VIAL (VERSED),J2250,HCPCS,636,RC,,1,ME,both,47.94,33.56,,,,,,,,,,,,,,,,,,,Other,10.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.14,10.34, DURICEF CAP 500MG,250,RC,,,,1,ME,both,10.23,7.16,,,,,,,,,,,,,,,,,,,Other,2.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.2,2.2, JOBST THIGH HIGH LARGE B,258,RC,,,,1,EA,both,337.9,236.53,,,,,,,,,,,,,,,,,,,Other,72.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,72.85,72.85, ACETYLCYSTINE 20% 30ML ORAL SOL(MUCO,250,RC,,,,1,ML,both,41.48,29.04,,,,,,,,,,,,,,,,,,,Other,8.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.95,8.95, TERBINAFINE 250MG TAB (LAMISIL),637,RC,,,,1,ME,both,34.84,24.39,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, TORSEMIDE 20MG TAB (DEMADEX),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, LIDOCAINE 1% W/EPI 20ML (XYLOCAINE),250,RC,,,,1,ML,both,35.15,24.61,,,,,,,,,,,,,,,,,,,Other,7.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.58,7.58, LIDOCAINE MPF 2% 10ML POLYAMP (XYLO),J2003,HCPCS,636,RC,,1,EA,both,35.15,24.61,,,,,,,,,,,,,,,,,,,Other,7.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.58,7.58, ROPIVACAINE 1% 10MG/ML 20ML INJ (NAROPIN,J2795,HCPCS,636,RC,,1,ME,both,120.53,84.37,,,,,,,,,,,,,,,,,,,Other,25.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.05,25.99, CARVEDILOL 6.25MG TAB (COREG),637,RC,,,,1,ME,both,8.72,6.1,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, MECLIZINE HCL 25MG TAB (ANTIVERT),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, METOPROLOL XL SUCC 50MG (TOPROL XL),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, KETAMINE 500MG/10 ML INJ (KETALAR),250,RC,,,,1,ME,both,86,60.2,,,,,,,,,,,,,,,,,,,Other,18.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.54,18.54, VANCOMYCIN 1000MG INJ (VANCOCIN),J3373,HCPCS,636,RC,,1,ME,both,82.04,57.43,,,,,,,,,,,,,,,,,,,Other,17.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.03,17.69, CARBAMAZEPINE ER 200MG TAB (TEGRETOL),637,RC,,,,1,ME,both,18.89,13.22,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DAKINS 1/2 STR 0.25% 473ML,250,RC,,,,1,ML,both,79.55,55.69,,,,,,,,,,,,,,,,,,,Other,17.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.15,17.15, RALOXIFENE 60MG TAB,637,RC,,,,1,ME,both,32.44,22.71,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, STERILE TALC PACKET,250,RC,,,,1,EA,both,181.89,127.32,,,,,,,,,,,,,,,,,,,Other,39.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.22,39.22, CLOPIDOGREL 75MG TAB (PLAVIX),637,RC,,,,1,ME,both,15.21,10.65,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, OLOPATADINE OPHTH 0.1% 5ML (PATANOL),637,RC,,,,1,ME,both,250.74,175.52,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, MIRTAZAPINE 15MG TAB,637,RC,,,,1,ME,both,11.06,7.74,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FLUTICASONE NASAL SPRAY 0.05% (FLONASE),250,RC,,,,1,EA,both,366.62,256.63,,,,,,,,,,,,,,,,,,,Other,79.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,79.05,79.05, MINOCYCLINE 100MG CAP (MINOCIN),A9270,HCPCS,637,RC,,1,ME,both,8.75,6.13,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, LEVOFLOXACIN 500MG/100ML IVPB PREMIX,J1956,HCPCS,636,RC,,1,ME,both,189.43,132.6,,,,,,,,,,,,,,,,,,,Other,40.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.12,40.84, HYDROCORTISONE 25MG SUPPS (ANUCORT HC),637,RC,,,,1,ME,both,105.29,73.7,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, TETANUS TOX PF SDV VIAL,90389,HCPCS,636,RC,,1,EA,both,108.08,75.66,,,,,,,,,,,,,,,,,,,Other,23.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.3,23.3, BECAPLERMIN GEL 0.01% 15GM (REGRANEX),S0157,HCPCS,636,RC,,1,GM,both,1988.77,1392.14,,,,,,,,,,,,,,,,,,,Other,428.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,428.78,428.78, FENTANYL 100MCG/2ML INJ (SUBLIMAZE),J3010,HCPCS,636,RC,,1,ME,both,33.41,23.39,,,,,,,,,,,,,,,,,,,Other,7.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.17,7.2, NACL 0.9% 10ML SALINE LOCK/ FLUSH,250,RC,,,,1,ML,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,1.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.49,1.49, HYDRALAZINE 25MG TAB,637,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, MORRHUATE SOD INJ 5% 30ML VIAL,250,RC,,,,1,ML,both,234.18,163.93,,,,,,,,,,,,,,,,,,,Other,50.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.49,50.49, LEVOTHYROXINE 0.112MG TAB (SYNTHROID),637,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, MONTELUKAST 10MG TAB,250,RC,,,,1,ME,both,11.06,7.74,,,,,,,,,,,,,,,,,,,Other,2.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.38,2.38, ANTIPYRINE/BENZOCAINE OTIC SOLN(AURALGAN,250,RC,,,,1,EA,both,27.01,18.91,,,,,,,,,,,,,,,,,,,Other,5.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.82,5.82, ASPIRIN 325MG TAB,637,RC,,,,1,ME,both,6.95,4.87,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DOXAZOSIN 4MG TAB (CARDURA),250,RC,,,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,1.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.61,1.61, AMOXICILLIN 250MG/5ML 80ML SUSP,637,RC,,,,1,ME,both,38,26.6,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, OLANZAPINE 5MG TAB (ZYPREXA),637,RC,,,,1,ME,both,94.45,66.12,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, RIZATRIPTAN MLT 10MG TAB (MAXALT),250,RC,,,,1,ME,both,142.92,100.04,,,,,,,,,,,,,,,,,,,Other,30.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,30.81,30.81, GLYBURIDE 2.5MG TAB (DIABETA),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, HYDROXYZINE HCL 25MG TAB (ATARAX),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, BELLADONNA&OPIUM 16A 16.2MG/60MG SUPP,250,RC,,,,1,ME,both,233.23,163.26,,,,,,,,,,,,,,,,,,,Other,50.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.28,50.28, CYANOCOBALAMIN INJ 1000,250,RC,,,,1,ME,both,17.15,12.01,,,,,,,,,,,,,,,,,,,Other,3.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.69,3.69, LORAZEPAM TAB 0.5MG,250,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,1.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.7,1.7, AMOXICILLIN/CLAVULANATE 500/125MG TAB,637,RC,,,,1,ME,both,20.33,14.23,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, HYDROCORTISONE 250MG/2ML INJ (SOLU-CORT,250,RC,,,,1,ME,both,194.79,136.35,,,,,,,,,,,,,,,,,,,Other,41.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.99,41.99, HYDROCORTISONE 100MG/2ML INJ (SOLU-CORTE,250,RC,,,,1,ME,both,121.91,85.34,,,,,,,,,,,,,,,,,,,Other,26.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.28,26.28, BACITRACIN OINT 500U/G,250,RC,,,,1,UN,both,27.9,19.53,,,,,,,,,,,,,,,,,,,Other,6.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.02,6.02, TERBUTALINE 2.5MG TAB (BRETHINE),637,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, METHYLPREDNISOLONE 500MG/4ML INJ,J2919,HCPCS,636,RC,,1,ME,both,244.5,171.15,,,,,,,,,,,,,,,,,,,Other,52.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.25,52.71, POTASSIUM IODIDE SOLUTION 1000MG/ML,250,RC,,,,1,ME,both,56.94,39.86,,,,,,,,,,,,,,,,,,,Other,12.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.28,12.28, BUMETANIDE 1MG TAB (BUMEX),637,RC,,,,1,ME,both,9.2,6.44,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CAPTOPRIL 25MG TAB (CAPOTEN),637,RC,,,,1,ME,both,13,9.1,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, SUCRALFATE 1000MG TAB (CARAFATE),250,RC,,,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,1.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.61,1.61, DILTIAZEM HCL 30MG TAB (CARDIZEM),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, SILVER SULFADIAZINE 1% CREAM 400GM(SILVA,250,RC,,,,1,GM,both,279.29,195.5,,,,,,,,,,,,,,,,,,,Other,60.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,60.21,60.21, MULTIVITAMIN 10ML INJ,250,RC,,,,1,ML,both,296.45,207.52,,,,,,,,,,,,,,,,,,,Other,63.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,63.92,63.92, LEVOTHYROXINE 0.125MG TAB (SYNTHROID),250,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,1.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.57,1.57, LEVALBUTEROL 0.63MG NEB (XOPENEX),J7614,HCPCS,250,RC,,1,ME,both,31.15,21.81,,,,,,,,,,,,,,,,,,,Other,6.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.08,6.71, IPRATROPIUM/ALBUTEROL INHALER (COMBIVENT,250,RC,,,,1,EA,both,2378.97,1665.28,,,,,,,,,,,,,,,,,,,Other,512.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,512.9,512.9, CARVEDILOL 3.125MG TAB (COREG),250,RC,,,,1,ME,both,9.29,6.5,,,,,,,,,,,,,,,,,,,Other,2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2,2, SCLEROSOL AEROSOL (STERILE TALC),250,RC,,,,1,EA,both,840.65,588.46,,,,,,,,,,,,,,,,,,,Other,181.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,181.24,181.24, PAROXETINE 10MG TAB (PAXIL),637,RC,,,,1,ME,both,11.62,8.13,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, SODIUM BICARB 650MG TAB,637,RC,,,,1,ME,both,5.81,4.07,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, TAMULOSIN 0.4MG CAP (FLOMAX),637,RC,,,,1,ME,both,19.57,13.7,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, TERBUTALINE 1MG/ML 1ML INJ (BRETHINE),J3105,HCPCS,636,RC,,1,ME,both,35.45,24.82,,,,,,,,,,,,,,,,,,,Other,7.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.42,7.64, LORATADINE 10MG TAB (CLARITIN),637,RC,,,,1,ME,both,11.06,7.74,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CLINDAMYCIN HCL 150MG CAP (CLEOCIN),637,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, BENZTROPINE MESYLATE 1MG TAB (COGENTIN),637,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CLARITHROMYCIN 500MG TAB (BIAXIN),637,RC,,,,1,ME,both,27.55,19.29,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, BETOPTIC OPTH SOL 0.5% 5ML,250,RC,,,,1,ML,both,115.04,80.53,,,,,,,,,,,,,,,,,,,Other,24.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.8,24.8, COLCHICINE 0.6MG TAB (COLCRYS),250,RC,,,,1,ME,both,51.84,36.29,,,,,,,,,,,,,,,,,,,Other,11.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.17,11.17, BISMUTH SUSP 8OZ (KAOPECTATE),250,RC,,,,1,ML,both,35.15,24.61,,,,,,,,,,,,,,,,,,,Other,7.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.58,7.58, OXYBUTYNIN 5MG TAB (DITROPAN),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PROCHLORPERAZINE 10MG TAB (COMPAZINE),Q0164,HCPCS,636,RC,,1,ME,both,7.63,5.34,,,,,,,,,,,,,,,,,,,Other,1.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.43,1.65, THEOCLEAR LA 260 CAPS 2,250,RC,,,,1,EA,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,1.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.7,1.7, MUPIROCIN OINT 2% 22 GM (BACTROBAN),250,RC,,,,1,GM,both,183.34,128.34,,,,,,,,,,,,,,,,,,,Other,39.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.52,39.52, NADOLOL 40MG TAB (CORGARD),250,RC,,,,1,ME,both,17.57,12.3,,,,,,,,,,,,,,,,,,,Other,3.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.79,3.79, FLUDROCORTISONE 0.1MG TAB (FLORINEF),250,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,1.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.7,1.7, LIDOCAINE INJ 1% 50ML MDV (XYLOCAINE),250,RC,,,,1,ML,both,29.35,20.55,,,,,,,,,,,,,,,,,,,Other,6.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.33,6.33, COUMADIN TAB 2.5MG,250,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,1.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.57,1.57, WARFARIN 2MG TAB (COUMADIN),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DILTIAZEM CD 180MG CAP (CARDIZEM),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, MAGNESIUM ALUM 30ML U/D SUSP (MAALOX),637,RC,,,,1,ME,both,24.37,17.06,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NIFEDIPINE 10MG CAP (PROCARDIA),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ACYCLOVIR 500MG INJ (ZOVIRAX),J0133,HCPCS,636,RC,,1,ME,both,231.5,162.05,,,,,,,,,,,,,,,,,,,Other,49.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.12,49.91, TRAZODONE 50MG TAB (DESERYL),637,RC,,,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, RIFAMPIN 300MG TAB,637,RC,,,,1,ME,both,8.68,6.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FUROSEMIDE 40MG/4ML INJ,J1938,HCPCS,636,RC,,1,ME,both,50.26,35.18,,,,,,,,,,,,,,,,,,,Other,10.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.02,10.84, DOXAPRAM 20MG/ML 20ML (DOPRAM),250,RC,,,,1,ME,both,384.12,268.88,,,,,,,,,,,,,,,,,,,Other,82.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,82.82,82.82, GLYBURIDE 5MG TAB (DIABETA),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ISOSORBIDE MONO 20MG,250,RC,,,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,1.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.61,1.61, TETANUS TOX PED VACCINE,250,RC,,,,1,EA,both,89.78,62.85,,,,,,,,,,,,,,,,,,,Other,19.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.36,19.36, DIGOXIN 0.25MG TAB (LANOXIN),637,RC,,,,1,ME,both,11.33,7.93,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DIGOXIN 0.125MG TAB (LANOXIN),250,RC,,,,1,ME,both,13.37,9.36,,,,,,,,,,,,,,,,,,,Other,2.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.88,2.88, SINCALIDE 5MCG INJ (KINEVAC),J2805,HCPCS,636,RC,,1,ME,both,705.01,493.51,,,,,,,,,,,,,,,,,,,Other,152,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,107.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,107.93,152, GEMFIBROZIL 600MG TAB (LOPID),637,RC,,,,1,ME,both,9.95,6.97,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PHENYTOIN 100MG CAP (DILANTIN),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, SCOPOLAMINE SCOP DISC (TRANSDERM SCOP),250,RC,,,,1,EA,both,109.89,76.92,,,,,,,,,,,,,,,,,,,Other,23.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.7,23.7, CAPTOPRIL 12.5MG TAB (CAPOTEN),250,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,1.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.57,1.57, DIGOXIN 0.50MG/2ML INJ (LANOXIN),J1160,HCPCS,636,RC,,1,ME,both,70.95,49.67,,,,,,,,,,,,,,,,,,,Other,15.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.38,15.3, ASPIRIN 600MG SUPP,637,RC,,,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, BUSPIRONE 10MG TAB (BUSPAR),637,RC,,,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ASPIRIN 300MG SUPP,637,RC,,,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, AMPICILLIN 1000 MG INJ,J0290,HCPCS,636,RC,,1,ME,both,43.58,30.51,,,,,,,,,,,,,,,,,,,Other,9.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.58,9.4, ACETAMINOPHEN 325MG SUPP (TYLENOL),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CLONAZEPAM 0.5MG TAB (KLONOPIN),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, AMPICILLIN 2000MG INJ,J0290,HCPCS,636,RC,,1,ME,both,42.13,29.49,,,,,,,,,,,,,,,,,,,Other,9.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.58,9.08, CIPROFLOXACIN 500MG TAB (CIPRO),637,RC,,,,1,ME,both,20.33,14.23,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, TRIMETHOBENZAMIDE 200MG/2ML INJ (TIGAN),J3250,HCPCS,636,RC,,1,ME,both,35.15,24.61,,,,,,,,,,,,,,,,,,,Other,7.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.58,34.45, AMINOPHYLLINE INJ 25MG/ML 10ML,J0280,HCPCS,636,RC,,1,ME,both,73.82,51.67,,,,,,,,,,,,,,,,,,,Other,15.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.2,15.92, DIPHENHYDRAMINE 50MG/ML INJ (BENADRYL),J1200,HCPCS,636,RC,,1,ME,both,33.41,23.39,,,,,,,,,,,,,,,,,,,Other,7.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.7,7.2, TRIAM/HCTZ 37.5/25MG CAP (DYAZIDE),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ASPIRIN EC 325MG TAB,637,RC,,,,1,ME,both,6.95,4.87,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CLINDAMYCIN 300MG/2ML 2ML INJ (CLEOCIN),250,RC,,,,1,ME,both,54.2,37.94,,,,,,,,,,,,,,,,,,,Other,11.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.68,11.68, guaiFENesin W/CODEINE 5ML U/D ELIXIR (T,637,RC,,,,1,ME,both,5.8,4.06,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, THROMBIN TOPICAL 5000 IU,250,RC,,,,1,UN,both,391.04,273.73,,,,,,,,,,,,,,,,,,,Other,84.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,84.31,84.31, ERYTHROMYCIN 250MG TAB (ERY-TAB),250,RC,,,,1,ME,both,71.13,49.79,,,,,,,,,,,,,,,,,,,Other,15.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.34,15.34, SALINE ENEMA (FLEET),637,RC,,,,1,EA,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FERROUS SULFATE 325 MG TAB,637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ERYTHROMYCIN 1000MG INJ (ERITHROCIN),J1364,HCPCS,636,RC,,1,ME,both,566.27,396.39,,,,,,,,,,,,,,,,,,,Other,122.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.76,122.09, TRIAMCINOLONE 40MG/1ML INJ (KENALOG),J3301,HCPCS,636,RC,,1,ME,both,49.69,34.78,,,,,,,,,,,,,,,,,,,Other,10.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.73,10.71, POTASSIUM CHLORIDE 40MEQ/20ML INJ,250,RC,,,,1,ME,both,108.36,75.85,,,,,,,,,,,,,,,,,,,Other,23.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.36,23.36, CLONIDINE TTS-3 PATCH (CATAPRES),637,RC,,,,1,EA,both,332.65,232.86,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, POTASSIUM CHLORIDE 10MEQ/5ML INJ,250,RC,,,,1,ML,both,33.41,23.39,,,,,,,,,,,,,,,,,,,Other,7.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.2,7.2, CYCLOBENZAPRINE 10MG TAB (FLEXERIL),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FOLIC ACID 1MG TAB,250,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,1.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.57,1.57, LACTULOSE 10GM/15ML U/D CUP,250,RC,,,,1,ME,both,10.74,7.52,,,,,,,,,,,,,,,,,,,Other,2.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.31,2.31, LINCOMYCIN 300MG/ML INJ (LINCOCIN),250,RC,,,,1,ME,both,170.28,119.2,,,,,,,,,,,,,,,,,,,Other,36.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.71,36.71, HALOPERIDOL 5MG TAB,637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, HALOPERIDOL 1MG TAB,637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CEFOXITIN 1000MG INJ (MEFOXIN),J0694,HCPCS,636,RC,,1,ME,both,54.34,38.04,,,,,,,,,,,,,,,,,,,Other,11.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.65,11.71, CHLORPROMAZINE 25MG/1ML INJ (THORAZIN,J3230,HCPCS,636,RC,,1,ME,both,170.8,119.56,,,,,,,,,,,,,,,,,,,Other,36.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.29,36.83, CHLORPROMAZINE 25MG TAB,Q0161,HCPCS,636,RC,,1,ME,both,35.62,24.93,,,,,,,,,,,,,,,,,,,Other,7.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.68,7.68, CITRATE OF MAG 300ML LIQ,637,RC,,,,1,ME,both,10.84,7.59,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, MINERAL OIL 472ML BOTTLE,250,RC,,,,1,ML,both,30.53,21.37,,,,,,,,,,,,,,,,,,,Other,6.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.59,6.59, HYDROXYUREA 500MG CAP (HYDREA),637,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, MILK OF MAG SUSP 30 ML,250,RC,,,,1,ML,both,10.36,7.25,,,,,,,,,,,,,,,,,,,Other,2.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.23,2.23, HYDROCODONE & CHLORPHENIRAMINE 5ML SUSP,637,RC,,,,1,ML,both,33.41,23.39,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, guaiFENesin 200MG/10ML (ROBITUSSIN),637,RC,,,,1,ME,both,6.63,4.64,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, LOPERAMIDE HCL 2MG CAP (IMODIUM),637,RC,,,,1,ME,both,8.92,6.24,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, METHYLPREDNISOLONE 40MG/1ML INJ (SOLU-ME,J2919,HCPCS,636,RC,,1,ME,both,35.15,24.61,,,,,,,,,,,,,,,,,,,Other,7.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.25,7.58, ACETAMINOPHEN SUPP 650MG (TYLENOL),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, METHYLPREDNISOLONE 1000 MG/8ML INJ,J2919,HCPCS,636,RC,,1,ME,both,301.59,211.11,,,,,,,,,,,,,,,,,,,Other,65.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.25,65.02, METHYLPREDNISOLONE 125 MG/2ML INJ,J2919,HCPCS,636,RC,,1,ME,both,60.11,42.08,,,,,,,,,,,,,,,,,,,Other,12.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.25,12.96, PROPRANOLOL LA 80MG CAP (INDERAL LA),637,RC,,,,1,ME,both,10.36,7.25,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, STADOL INJ 2MG/ML,J0595,HCPCS,636,RC,,1,ME,both,41.25,28.88,,,,,,,,,,,,,,,,,,,Other,8.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.43,8.9, PROPRANOLOL 40MG TAB (INDERAL),637,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CLONIDINE HCL 0.1MG TAB,637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CLONIDINE HCL 0.2MG TAB,637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DIAZEPAM 10MG/2ML INJ (VALIUM),J3360,HCPCS,636,RC,,1,ME,both,160.1,112.07,,,,,,,,,,,,,,,,,,,Other,34.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.56,34.52, INDOMETHACIN 25MG CAP (INDOCIN),250,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,1.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.49,1.49, MORPHINE SULFATE 2MG/ML INJ,J2270,HCPCS,636,RC,,1,ME,both,33.46,23.42,,,,,,,,,,,,,,,,,,,Other,7.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.98,7.21, COUMADIN TABS 7.5MG,250,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,1.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.57,1.57, LIDOCAINE 2% 5ML VIAL,J2003,HCPCS,636,RC,,1,ML,both,33.41,23.39,,,,,,,,,,,,,,,,,,,Other,7.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.2,7.2, D5W/0.45%NS + 20MEQ KCL 1000ML IV FLUID,J3480,HCPCS,636,RC,,1,ML,both,81.05,56.74,,,,,,,,,,,,,,,,,,,Other,17.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.12,17.47, TOBRAMYCIN & dexAMETHasone OPTH 2.5ML,637,RC,,,,1,EA,both,267.88,187.52,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ISOSORBIDE DINITRATE 20MG TAB (ISORDIL),250,RC,,,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,1.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.61,1.61, CEPHALEXIN 250MG CAP (KEFLEX),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FUROSEMIDE 100MG/10ML INJ,J1938,HCPCS,636,RC,,1,ME,both,33.41,23.39,,,,,,,,,,,,,,,,,,,Other,7.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.02,7.2, HYDROCORTISONE 100MG/60ML (CORTENEMA),250,RC,,,,1,ME,both,110.57,77.4,,,,,,,,,,,,,,,,,,,Other,23.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.84,23.84, FUROSEMIDE 40MG TAB (LASIX),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FUROSEMIDE 20MG TAB (LASIX),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FUROSEMIDE 80MG TAB (LASIX),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, LEVOTHROID TABS 25MCG,250,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,1.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.7,1.7, LEVOTHROID TABS 150MCG,250,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,1.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.7,1.7, AZTREONAM INJ 1000MG (AZACTAM),J0457,HCPCS,250,RC,,1,ME,both,186.17,130.32,,,,,,,,,,,,,,,,,,,Other,40.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.19,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.19,40.14, LEVOTHROID TABS 100MCG,250,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,1.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.7,1.7, LEVOTHROID TABS 50MCG,250,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,1.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.7,1.7, LIDOCAINE 1% 20ML INJ (XYLOCAINE),J2003,HCPCS,636,RC,,1,ML,both,33.41,23.39,,,,,,,,,,,,,,,,,,,Other,7.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.2,7.2, LEVOTHYROXINE 0.1MG TAB (SYNTHROID),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CALCIUM CHLORIDE 10ML INJ,250,RC,,,,1,ME,both,26.83,18.78,,,,,,,,,,,,,,,,,,,Other,5.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.78,5.78, CHLORDIAZEPOXIDE 25MG CAP (LIBRIUM),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DIPHENOXYLATE/ATROPINE TAB (LOMOTIL),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, HYOSCYAMINE 0.125MG SL TAB,637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, METOPROLOL TART 50MG TAB (LOPRESSOR),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NOREPINEPHRINE BITART 4MG/4ML INJ (LE,250,RC,,,,1,ME,both,55.21,38.65,,,,,,,,,,,,,,,,,,,Other,11.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.91,11.91, NITROFURANTOIN 100MG CAP (MACROBID),637,RC,,,,1,ME,both,18.43,12.9,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NITROFURANTOIN 50MG CAP (MACRODANTIN),637,RC,,,,1,ME,both,19,13.3,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CHLORDIAZEPOXIDE 5MG CAP (LIBRIUM),250,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,1.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.7,1.7, GLYCOPYRROLATE 0.4MG/2ML INJ (ROBINUL),J1596,HCPCS,636,RC,,1,ME,both,133.66,93.56,,,,,,,,,,,,,,,,,,,Other,28.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.37,28.82, TIROFIBAN 12.5 MG/250ML PREMIX (AGGRASTA,J3246,HCPCS,636,RC,,1,ME,both,2070.12,1449.08,,,,,,,,,,,,,,,,,,,Other,446.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.38,446.32, DEXTROSE 5% 100 CC BAG,250,RC,,,,1,ML,both,27.6,19.32,,,,,,,,,,,,,,,,,,,Other,5.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.95,5.95, IRON DEXTRAN 100MG/2ML INJ (INFED),J1750,HCPCS,636,RC,,1,ME,both,201,140.7,,,,,,,,,,,,,,,,,,,Other,43.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.72,43.34, CELECOXIB 100MG CAP (CeleBREX),637,RC,,,,1,ME,both,18.78,13.15,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CELECOXIB 200MG CAP (CELEBREX),250,RC,,,,1,ME,both,32.6,22.82,,,,,,,,,,,,,,,,,,,Other,7.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.03,7.03, LEVOTHYROXINE SOD 0.088MG,637,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, BAC/NEO/POLY OPHTH OINT 3.5GM OINT(NEOSP,250,RC,,,,1,EA,both,72.34,50.64,,,,,,,,,,,,,,,,,,,Other,15.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.59,15.59, FUROSEMIDE 20 MG INJ,J1938,HCPCS,636,RC,,1,ME,both,33.41,23.39,,,,,,,,,,,,,,,,,,,Other,7.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.02,7.2, CALCITONIN NASAL SPRAY 3.7ML (MIACALCIN),637,RC,,,,1,ML,both,509.72,356.8,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PROCHLORPERAZINE 25MG SUPPS,J8498,HCPCS,636,RC,,1,ME,both,52.71,36.9,,,,,,,,,,,,,,,,,,,Other,11.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.37,11.37, PSYLLIUM PKT (METAMUCIL),637,RC,,,,1,EA,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ENALAPRILAT 1.25MG/ML SDV (VASOTEC),250,RC,,,,1,ME,both,67.99,47.59,,,,,,,,,,,,,,,,,,,Other,14.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.66,14.66, OMEPRAZOLE 20MG CAP (PRILOSEC),637,RC,,,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, METHYLPREDNISOLONE ACE 40MG/ML INJ (DEPO,J1010,HCPCS,636,RC,,1,ME,both,56.13,39.29,,,,,,,,,,,,,,,,,,,Other,12.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.12,12.1, FENTANYL 25MCG/HR PATCH (DURAGESIC),250,RC,,,,1,EA,both,94.38,66.07,,,,,,,,,,,,,,,,,,,Other,20.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.34,20.34, MEPERIDINE HCL INJ 25MG,250,RC,,,,1,ME,both,35.45,24.82,,,,,,,,,,,,,,,,,,,Other,7.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.64,7.64, MEPERIDINE HCL 50MG INJ (DEMEROL),J2175,HCPCS,636,RC,,1,ME,both,33.41,23.39,,,,,,,,,,,,,,,,,,,Other,7.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.2,7.99, BACLOFEN 10MG TAB,637,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, SIMETHICONE 80MG CHEW TAB,637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, MIDAZOLAM 2MG/2ML VIAL (VERSED),J2250,HCPCS,636,RC,,1,ME,both,33.41,23.39,,,,,,,,,,,,,,,,,,,Other,7.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.14,7.2, SODIUM PHOSPHATE 45MMOL/15ML INJ,250,RC,,,,1,ML,both,94.31,66.02,,,,,,,,,,,,,,,,,,,Other,20.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.34,20.34, VANCOMYCIN INJ 500MG,J3373,HCPCS,636,RC,,1,ME,both,53.74,37.62,,,,,,,,,,,,,,,,,,,Other,11.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.03,11.58, NAPROXEN 500MG TAB (NAPROSYN),637,RC,,,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NYSTOP 60GM TOPICAL PWD (MYCOSTATIN),250,RC,,,,1,GM,both,412.28,288.6,,,,,,,,,,,,,,,,,,,Other,88.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,88.89,88.89, CYANOCOBALAMIN 1000MCG INJ (VIT B12),J3420,HCPCS,636,RC,,1,ME,both,55.69,38.98,,,,,,,,,,,,,,,,,,,Other,12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.63,12, NEOMYCIN SULF 500MG TAB,637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NITROGLYCERIN 0.4MG/HR PATCH (NITRO-DUR),637,RC,,,,1,ME,both,13.07,9.15,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FENTANYL 50MCG/HR PATCH (DURAGESIC),250,RC,,,,1,ME,both,113.35,79.35,,,,,,,,,,,,,,,,,,,Other,24.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.44,24.44, VEPESID INJ 20MG/ML,250,RC,,,,1,ME,both,620.6,434.42,,,,,,,,,,,,,,,,,,,Other,133.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,133.8,133.8, DIPHENHYDRAMINE 12.5MG/5ML ELIXIR (BENAD,J1200,HCPCS,636,RC,,1,ME,both,33.74,23.62,,,,,,,,,,,,,,,,,,,Other,7.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.7,7.27, CARBAMIDE PEROXIDE 6.5% EARWAX REMOVAL,250,RC,,,,1,ME,both,32.64,22.85,,,,,,,,,,,,,,,,,,,Other,7.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.04,7.04, VANCOMYCIN 500MG INJ (VANCOCIN),J3373,HCPCS,636,RC,,1,ME,both,44.45,31.12,,,,,,,,,,,,,,,,,,,Other,9.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.03,9.58, GUAIFENSIN 200MG TAB (ORGANIDIN),637,RC,,,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, BUPIVACAINE 0.25% W/ EPI 10ML VIAL,250,RC,,,,1,ML,both,59.86,41.9,,,,,,,,,,,,,,,,,,,Other,12.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.91,12.91, NEO/POLY/DEX OPHTH SUSP(MAXITROL SUSP),250,RC,,,,1,EA,both,189.2,132.44,,,,,,,,,,,,,,,,,,,Other,40.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.79,40.79, CALCIUM 500+D TAB (OS-CAL+D),637,RC,,,,1,EA,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, METHYLPREDNISOLONE 4MG DOSEPAK (MEDROL,J7509,HCPCS,636,RC,,1,ME,both,56.69,39.68,,,,,,,,,,,,,,,,,,,Other,12.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.14,12.22, PENICILLIN V POTASSIUM 250MG TAB(PEN-VK),637,RC,,,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DIPYRIDAMOLE 25MG TAB (PERSANTINE),250,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,1.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.57,1.57, PHENOBARBITAL 32.4 MG TAB,637,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PREDNISONE 20MG TAB,J7512,HCPCS,636,RC,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,1.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.57,1.57, MORPHINE SULFATE PCA 30MG/30ML,J2270,HCPCS,636,RC,,1,ME,both,73.56,51.49,,,,,,,,,,,,,,,,,,,Other,15.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.98,15.86, PREDNISONE 10MG TAB,637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, MEPERIDINE PCA 300MG (DEMEROL),J2175,HCPCS,636,RC,,1,ME,both,83.09,58.16,,,,,,,,,,,,,,,,,,,Other,17.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.99,17.91, PREDNISONE 5MG TAB,637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NITROGLYCERIN 0.4MG (1/150 GR) #25 (NIT,637,RC,,,,1,ME,both,109.18,76.43,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CONJUGATED ESTROGENS 0.625MG TAB (PREMAR,637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, EYE WASH 118ML SOL (PURIFIED WATER),250,RC,,,,1,ML,both,26.27,18.39,,,,,,,,,,,,,,,,,,,Other,5.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.66,5.66, VITAMIN C 500MG TAB (ASCORBIC ACID),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PHENYLEPHRINE 10MG/1ML INJ (NEO),J2371,HCPCS,636,RC,,1,ME,both,39.23,27.46,,,,,,,,,,,,,,,,,,,Other,8.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.46,8.46, BETHANECHOL 10MG TAB (URECHOLINE),637,RC,,,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, AMPICILLIN & SULBACTAM 1500MG INJ(UNASYN,J0295,HCPCS,636,RC,,1,ME,both,43.58,30.51,,,,,,,,,,,,,,,,,,,Other,9.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.3,9.4, PHENYTOIN INJ 50MG/ML 5ML VIAL (DILANTIN,J1165,HCPCS,636,RC,,1,ME,both,35.15,24.61,,,,,,,,,,,,,,,,,,,Other,7.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.59,7.58, PHENYTOIN 125MG/5ML 237ML SUSP (DILANTIN,250,RC,,,,1,ME,both,158.53,110.97,,,,,,,,,,,,,,,,,,,Other,34.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.18,34.18, PHENAZOPYRIDINE 100MG TAB (PYRIDIUM),637,RC,,,,1,ME,both,11.61,8.13,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, VERAPAMIL HCL 80MG TAB (CALAN),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CHOLESTYRAMINE PWD PKT (QUESTRAN),637,RC,,,,1,EA,both,15.68,10.98,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, TRAMADOL 50MG TAB (ULTRAM),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, TOBRAMYCIN OPTH 0.3% 5ML SOL,637,RC,,,,1,EA,both,158.05,110.64,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, BISACODYL SUPP 10MG,637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, AMPICILLIN & SULBACTAM 3000MG INJ(UNASYN,J0295,HCPCS,636,RC,,1,ME,both,75.14,52.6,,,,,,,,,,,,,,,,,,,Other,16.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.3,16.2, METOCLOPRAMIDE 10MG TAB (REGLAN),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, TEMAZEPAM 15MG CAP (RESTORIL),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ALBUTEROL SOL 0.5%-0.5ML DOSE,J7611,HCPCS,250,RC,,1,ML,both,4.06,2.84,,,,,,,,,,,,,,,,,,,Other,0.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.25,0.87, ACETAMINOPHEN 120MG SUPP (TYLENOL),637,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ERTHROMYCIN 200MG/5ML SUSP (E.E.S.),250,RC,,,,1,ME,both,1287.98,901.59,,,,,,,,,,,,,,,,,,,Other,277.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,277.69,277.69, RITALIN TABS 10MG,250,RC,,,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,1.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.61,1.61, ERYTHROMYCIN 500MG INJ (ERYTHROCIN),250,RC,,,,1,ME,both,1032,722.4,,,,,,,,,,,,,,,,,,,Other,222.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,222.5,222.5, METHYLPHENIDATE 5MG TAB (RITALIN),637,RC,,,,1,ME,both,10.59,7.41,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DAKINS 1/4 STR 0.125% 473ML,250,RC,,,,1,ML,both,75.25,52.68,,,,,,,,,,,,,,,,,,,Other,16.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.23,16.23, NARCAN INJ 0.4MG/ML,J2312,HCPCS,636,RC,,1,ME,both,35.45,24.82,,,,,,,,,,,,,,,,,,,Other,7.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.06,7.64, EPHEDRINE SULFATE INJ 50MG,250,RC,,,,1,ME,both,263.81,184.67,,,,,,,,,,,,,,,,,,,Other,56.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,56.88,56.88, EPINEPHRINE 1MG/ML AMP,J0169,HCPCS,250,RC,,1,ME,both,81.35,56.95,,,,,,,,,,,,,,,,,,,Other,17.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.35,17.54, TUBERSOL INJ 5TU/0.1ML,250,RC,,,,1,ML,both,17.15,12.01,,,,,,,,,,,,,,,,,,,Other,3.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.69,3.69, TRIAMCINOLONE 0.1% 15GM CRM (KENALOG),637,RC,,,,1,GM,both,27.9,19.53,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, SULFAMETHOXAZOLE/TMP DS 800/160MG TAB,637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, KETORALAC 30MG/1ML INJ (TORADOL),J1885,HCPCS,636,RC,,1,ME,both,45.63,31.94,,,,,,,,,,,,,,,,,,,Other,9.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.32,9.84, BUPIVACAINE 0.5% W/ EPI 10ML VIAL (MARCA,250,RC,,,,1,ML,both,84.32,59.02,,,,,,,,,,,,,,,,,,,Other,18.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.18,18.18, CARB/LEVO 10/100MG TAB (SINEMET),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CARB/LEVO 25/100MG TAB (SINEMET),637,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DOXEPIN HCL 10MG CAP (SINEQUAN),250,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,1.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.7,1.7, VERAPAMIL HCL 5MG/2ML INJ,250,RC,,,,1,ME,both,162.71,113.9,,,,,,,,,,,,,,,,,,,Other,35.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.08,35.08, ISOSORBIDE MONONITRATE 20MG TAB (ISMO),637,RC,,,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, KETOROLAC 10MG TAB (TORADOL),250,RC,,,,1,ME,both,6.25,4.38,,,,,,,,,,,,,,,,,,,Other,1.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.35,1.35, POTASSIUM CHLORIDE 8MEQ TAB (KLOR-CON),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CLONIDINE TTS -2 PATCH (CATAPRES),637,RC,,,,1,EA,both,240.06,168.04,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, LABETALOL 100MG TAB (TRANDATE),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, BUPIVACAINE 0.25% 10ML INJ (MARCAINE),250,RC,,,,1,ML,both,33.41,23.39,,,,,,,,,,,,,,,,,,,Other,7.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.2,7.2, MAGNESIUM SULFATE 50% ORAL LIQ 60ML,250,RC,,,,1,ML,both,35.15,24.61,,,,,,,,,,,,,,,,,,,Other,7.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.58,7.58, EPINEPH 1:10000 INJ ABBOJECT,J0169,HCPCS,250,RC,,1,EA,both,64.5,45.15,,,,,,,,,,,,,,,,,,,Other,13.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.35,13.91, ATENOLOL 50MG TAB (TENORMIN),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DOBUTamine 250MG/20ML INJ,J1250,HCPCS,636,RC,,1,ME,both,28.76,20.13,,,,,,,,,,,,,,,,,,,Other,6.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.2,7.86, MINERAL OIL LIGHT 10ML (MURI-LUBE),250,RC,,,,1,ML,both,103.1,72.17,,,,,,,,,,,,,,,,,,,Other,22.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.23,22.23, THEOPHYLLINE ER 400MG TAB (THEO-DUR),250,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,1.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.57,1.57, LIDOCAINE 0.5% 50ML VIAL (XYLOCAINE),J2003,HCPCS,636,RC,,1,ML,both,64.96,45.47,,,,,,,,,,,,,,,,,,,Other,14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14,14, LIDOCAINE 1% 5ML INJ MPF (XYLOCAINE),J2003,HCPCS,636,RC,,1,ML,both,33.41,23.39,,,,,,,,,,,,,,,,,,,Other,7.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.2,7.2, LIDOCAINE 0.5% W/EPI 50ML (XYLOCAINE MPF,250,RC,,,,1,ML,both,41.33,28.93,,,,,,,,,,,,,,,,,,,Other,8.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.91,8.91, XYLO 1%EPI 1:100000 INJ,250,RC,,,,1,EA,both,35.45,24.82,,,,,,,,,,,,,,,,,,,Other,7.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.64,7.64, AMITRIPTYLINE 10MG TAB (ELAVIL),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, MULTI VIT W/ MINERAL TAB,637,RC,,,,1,EA,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, THIAMINE 100MG TAB (VITAMIN B1),637,RC,,,,1,ME,both,55.5,38.85,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DOPAMINE 800MG/500ML PREMIX,J1265,HCPCS,636,RC,,1,ME,both,151.27,105.89,,,,,,,,,,,,,,,,,,,Other,32.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.78,32.61, TRIP ANTIBIOTIC OPHTH OI,250,RC,,,,1,EA,both,20.04,14.03,,,,,,,,,,,,,,,,,,,Other,4.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.32,4.32, PROPOFOL 200MG/20ML INJ,J2704,HCPCS,250,RC,,1,ME,both,31.08,21.76,,,,,,,,,,,,,,,,,,,Other,6.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.09,6.7, CEPHALEXIN 250MG/5ML 100ML SUSP (KELFEX),637,RC,,,,1,ME,both,73.21,51.25,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, MANNITOL 25% 50ML VIAL (ARIDOL),J2151,HCPCS,636,RC,,1,ML,both,101.2,70.84,,,,,,,,,,,,,,,,,,,Other,21.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.06,21.81, XYLOCAINE INJ 1% 50CC,250,RC,,,,1,ML,both,35.45,24.82,,,,,,,,,,,,,,,,,,,Other,7.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.64,7.64, LIDOCAINE 2% W/EPI SDV 10ML (XYLOCAINE M,250,RC,,,,1,ML,both,35.45,24.82,,,,,,,,,,,,,,,,,,,Other,7.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.64,7.64, NEO/POLY/DEX OPHTH OINT(MAXITROL OINT),250,RC,,,,1,EA,both,35.45,24.82,,,,,,,,,,,,,,,,,,,Other,7.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.64,7.64, LIDOCAINE TOPICAL 4% 50ML SOL (XYLOCAIN,250,RC,,,,1,ML,both,300.49,210.34,,,,,,,,,,,,,,,,,,,Other,64.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,64.79,64.79, ACETAMINOPHEN XS 500MG CAPLET (TYLENOL X,637,RC,,,,1,ME,both,6.76,4.73,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ACETAMINOPHEN W/CODEINE #3 TAB,637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, LIDOCAINE W/EPI INJ 1.5% 5ML (XYLOCAINE),250,RC,,,,1,ML,both,25.45,17.82,,,,,,,,,,,,,,,,,,,Other,5.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.49,5.49, NEO/POLY/GRAM OPHTH SOLN (NEOSPORIN),250,RC,,,,1,EA,both,287.93,201.55,,,,,,,,,,,,,,,,,,,Other,62.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,62.07,62.07, ACETAMINOPHEN 325MG TAB (TYLENOL),637,RC,,,,1,ME,both,7.3,5.11,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, LIDOCAINE JELLY 2% 30ML (XYLOCAINE),250,RC,,,,1,ML,both,567.92,397.54,,,,,,,,,,,,,,,,,,,Other,122.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,122.44,122.44, LIDOCAINE 2% 20MG/ML 5ML SYR (XYLOCAINE),J2003,HCPCS,636,RC,,1,ML,both,64.2,44.94,,,,,,,,,,,,,,,,,,,Other,13.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.84,13.84, DIAZEPAM 5MG TAB (VALIUM),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, WARFARIN 5MG TAB (COUMADIN),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, AMIODARONE 200MG TAB (PACERONE),637,RC,,,,1,ME,both,32.23,22.56,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ENALAPRIL 10MG TAB (VASOTEC),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ENALAPRIL 5MG TAB (VASOTEC),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DIPHENHYDRAMINE 25MG CAP(BENADRYL),J1200,HCPCS,636,RC,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,1.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.7,1.49, NICOTINE PATCH 21MG/DAY,250,RC,,,,1,EA,both,26.45,18.52,,,,,,,,,,,,,,,,,,,Other,5.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.7,5.7, NICOTINE PATCH 14MG/DAY,250,RC,,,,1,EA,both,27.6,19.32,,,,,,,,,,,,,,,,,,,Other,5.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.95,5.95, Nitroglycerin/D5W : 50MG/250ML PREMIX,250,RC,,,,1,ME,both,116.3,81.41,,,,,,,,,,,,,,,,,,,Other,25.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.08,25.08, FERROUS SULFATE 220MG ELIXIR,250,RC,,,,1,ME,both,35.15,24.61,,,,,,,,,,,,,,,,,,,Other,7.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.58,7.58, ALPRAZOLAM 0.5MG TAB (XANAX),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FENTANYL 250MCG/5ML INJ (SUBLIMAZE),J3010,HCPCS,636,RC,,1,ME,both,33.41,23.39,,,,,,,,,,,,,,,,,,,Other,7.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.17,7.2, CEPHALEXIN SUSP 250MG/5ML,250,RC,,,,1,ME,both,62.76,43.93,,,,,,,,,,,,,,,,,,,Other,13.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.53,13.53, NYSTATIN CREAM 30GM,250,RC,,,,1,ME,both,112.88,79.02,,,,,,,,,,,,,,,,,,,Other,24.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.33,24.33, DEXAMETHASONE 2MG TAB,J8540,HCPCS,636,RC,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,1.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.01,1.61, ORPHENADRINE 60MG/2ML 2ML INJ (NORFLEX),250,RC,,,,1,ME,both,109.51,76.66,,,,,,,,,,,,,,,,,,,Other,23.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.61,23.61, IRON COMPLEX 150MG CAP (FERREX),250,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,1.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.49,1.49, CECLOR SUSP 125MG/5ML,250,RC,,,,1,ME,both,83.97,58.78,,,,,,,,,,,,,,,,,,,Other,18.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.1,18.1, COSYNTROPIN 0.25MG INJ (CORTROSYN),J0834,HCPCS,636,RC,,1,ME,both,549.95,384.97,,,,,,,,,,,,,,,,,,,Other,118.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.24,118.57, METHYLENE BLUE 0.5% 10ML,Q9968,HCPCS,636,RC,,1,ML,both,1872.09,1310.46,,,,,,,,,,,,,,,,,,,Other,403.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,403.62,403.62, ALLOPURINOL 300MG TAB (ZYLOPRIM),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FLUOROURACIL 500MG/10ML INJ (ADRUCIL),J9190,HCPCS,636,RC,,1,ME,both,33.46,23.42,,,,,,,,,,,,,,,,,,,Other,7.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.9,7.21, DURAGESIC SYSTEM 75MCG,250,RC,,,,1,ME,both,149.91,104.94,,,,,,,,,,,,,,,,,,,Other,32.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.32,32.32, ALCOHOL DEHYDRATED 1ML AMP INJ,250,RC,,,,1,ML,both,51,35.7,,,,,,,,,,,,,,,,,,,Other,11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11,11, AMLODIPINE 10MG TAB,637,RC,,,,1,ME,both,11.06,7.74,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, AMLODIPINE 5 MG TAB,637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, LISINOPRIL 20MG TAB (ZESTRIL),637,RC,,,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CALCIUM 500MG TAB (OSCAL),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, METOLAZONE 5 MG TAB (ZAROXOLYN),250,RC,,,,1,ME,both,14.65,10.26,,,,,,,,,,,,,,,,,,,Other,3.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.16,3.16, BUPivacaine 0.5% INJ 10ML (MARCAINE),250,RC,,,,1,ME,both,35.15,24.61,,,,,,,,,,,,,,,,,,,Other,7.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.58,7.58, AZITHROMYCIN 250MG TAB (ZITHROMAX),Q0144,HCPCS,636,RC,,1,ME,both,33.41,23.39,,,,,,,,,,,,,,,,,,,Other,7.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.2,7.2, BISACODYL 5MG EC TAB (DULCOLAX),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ERYTHROMYCIN 250MG CAP (ERY-TAB),250,RC,,,,1,ME,both,26.69,18.68,,,,,,,,,,,,,,,,,,,Other,5.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.75,5.75, METHOTREXATE 2.5MG TAB,J8610,HCPCS,636,RC,,1,ME,both,15.39,10.77,,,,,,,,,,,,,,,,,,,Other,3.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.15,3.32, SALINE NASAL SPRAY (OCEAN),637,RC,,,,1,ME,both,16.28,11.4,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CLONIDINE TTS -1 PATCH (CATAPRES),637,RC,,,,1,EA,both,46.78,32.75,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DEXAMETHASONE 4MG/ML 5ML INJ SDV,J1100,HCPCS,636,RC,,1,ME,both,33.5,23.45,,,,,,,,,,,,,,,,,,,Other,7.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.1,7.22, DICYCLOMINE 10MG CAP (BENTYL),637,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DILTIAZEM 300MG CAP (CARDIZEM CD),250,RC,,,,1,ME,both,13,9.1,,,,,,,,,,,,,,,,,,,Other,2.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.8,2.8, DOXAZOSIN 1MG TAB (CARDURA),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DOXYCYCLINE 100MG INJ (VIBRAMYCIN),250,RC,,,,1,ME,both,129.86,90.9,,,,,,,,,,,,,,,,,,,Other,28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28,28, DOCUSATE SODIUM 100MG CAP (COLACE),250,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,1.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.57,1.57, VECURONIUM 10MG INJ (NORCURON),250,RC,,,,1,ME,both,104.81,73.37,,,,,,,,,,,,,,,,,,,Other,22.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.6,22.6, LABETALOL 100MG/20ML INJ (TRANDATE),250,RC,,,,1,ME,both,69.72,48.8,,,,,,,,,,,,,,,,,,,Other,15.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.03,15.03, NALBUPHINE 10MG/ML 1ML INJ (NUBAIN),J2300,HCPCS,636,RC,,1,ME,both,136.56,95.59,,,,,,,,,,,,,,,,,,,Other,29.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.38,29.44, DOCUSATE CALCIUM 240MG CAP (SURFAK),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PROSIGHT TAB (OCUVITE) I CAPS,250,RC,,,,1,EA,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,1.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.57,1.57, GENTAMYCIN OPTH SOL,250,RC,,,,1,EA,both,38.36,26.85,,,,,,,,,,,,,,,,,,,Other,8.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.27,8.27, POLYETHYLENE GLYCOL-ELECTROLYTE SOL (GOL,637,RC,,,,1,EA,both,136.18,95.33,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, GRANULEX AEROSOL 4OZ,250,RC,,,,1,ML,both,97.91,68.54,,,,,,,,,,,,,,,,,,,Other,21.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,21.11,21.11, GLYCERIN ADULT SUPP,250,RC,,,,1,EA,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,1.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.7,1.7, METRONIDAZOLE 500MG TAB (FLAGYL),637,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, GENTAMICIN SULFATE 0.1%OINT 15GM,250,RC,,,,1,GM,both,424.62,297.23,,,,,,,,,,,,,,,,,,,Other,91.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,91.55,91.55, GENTAMICIN OPHTH OINT 3.5GM(GENTAK),250,RC,,,,1,GM,both,91.41,63.99,,,,,,,,,,,,,,,,,,,Other,19.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.71,19.71, MORPHINE SULFATE 10MG/ML INJ,J2270,HCPCS,636,RC,,1,ME,both,31.81,22.27,,,,,,,,,,,,,,,,,,,Other,6.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.98,6.86, GLIPIZIDE 5MG TAB (GLUCOTROL),250,RC,,,,1,ME,both,7.72,5.4,,,,,,,,,,,,,,,,,,,Other,1.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.67,1.67, TETRACAINE 0.5% EYE DROP,250,RC,,,,1,EA,both,475.2,332.64,,,,,,,,,,,,,,,,,,,Other,102.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,102.45,102.45, DEXAMETHASONE SOD PHOS 10MG/ML 1ML INJ,J1100,HCPCS,636,RC,,1,ME,both,33.74,23.62,,,,,,,,,,,,,,,,,,,Other,7.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.1,7.27, OCTREOTIDE 100MCG/ML INJ (SANDOSTATIN),J2354,HCPCS,636,RC,,1,ME,both,76.05,53.24,,,,,,,,,,,,,,,,,,,Other,16.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.65,16.4, PNEUMOVAX 23 INJ 0.5ML,90732,HCPCS,636,RC,,1,EA,both,586.82,410.77,,,,,,,,,,,,,,,,,,,Other,126.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,130.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,126.52,130.8, CEFUROXIME 500MG TAB (CEFTIN),637,RC,,,,1,ME,both,35.15,24.61,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CEFPROZIL 250MG/5ML SUSP 50ML (CEFZIL),250,RC,,,,1,ME,both,147.31,103.12,,,,,,,,,,,,,,,,,,,Other,31.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,31.76,31.76, FAMOTIDINE 20MG TAB (PEPCID),250,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,1.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.57,1.57, LIDOCAINE VISCOUS 2% 100ML (XYLOCAINE),250,RC,,,,1,EA,both,58.41,40.89,,,,,,,,,,,,,,,,,,,Other,12.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.59,12.59, DICLOXACILLIN 250MG CAP,250,RC,,,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,1.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.61,1.61, FLUOXETINE 20MG CAP,637,RC,,,,1,ME,both,12.44,8.71,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, BACITRACIN OPHTH OINT 3.5GM TUBE,270,RC,,,,1,GM,both,332.09,232.46,,,,,,,,,,,,,,,,,,,Other,71.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.6,71.6, PENICILLIN G POTASSIUM 5MU INJ,250,RC,,,,1,UN,both,195.53,136.87,,,,,,,,,,,,,,,,,,,Other,42.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.16,42.16, ERYTHROMYCIN OPHTH OINT 0.5% (ILOTYCIN),250,RC,,,,1,ME,both,124.49,87.14,,,,,,,,,,,,,,,,,,,Other,26.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.84,26.84, DOXYCYCLINE 100MG CAP (VIBRAMYCIN),250,RC,,,,1,ME,both,24.61,17.23,,,,,,,,,,,,,,,,,,,Other,5.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.3,5.3, TUBERSOL 5TU/0.1ML INJ,250,RC,,,,1,ML,both,52.18,36.53,,,,,,,,,,,,,,,,,,,Other,11.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.25,11.25, Fluconazole/PREMIX IVPB: 400MG/200ML,J1450,HCPCS,636,RC,,1,ME,both,107.39,75.17,,,,,,,,,,,,,,,,,,,Other,23.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.39,23.16, FLUCONAZOLE 100MG TAB (DIFLUCAN),637,RC,,,,1,ME,both,40.99,28.69,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CONJUGATED ESTROGENS 25MG INJ (PREMARIN),J1410,HCPCS,636,RC,,1,ME,both,1945.58,1361.91,,,,,,,,,,,,,,,,,,,Other,419.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,383.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,383.92,419.47, HYDROXYZINE PAM 25MG CAP (VISTARIL),Q0177,HCPCS,636,RC,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,1.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.49,1.49, ALBUTEROL HFA 90MCG (VENTOLIN HFA),J3535,HCPCS,636,RC,,1,ME,both,378.23,264.76,,,,,,,,,,,,,,,,,,,Other,81.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.55,81.55, OXYTOCIN 10U/1ML INJ (PITOCIN),J2590,HCPCS,636,RC,,1,ME,both,35.45,24.82,,,,,,,,,,,,,,,,,,,Other,7.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.64,7.64, HALOPERIDOL LACT 5MG/1ML INJ,J1630,HCPCS,636,RC,,1,ME,both,35.15,24.61,,,,,,,,,,,,,,,,,,,Other,7.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.72,7.58, VASOPRESSIN INJ 10U/0.5,250,RC,,,,1,UN,both,35.45,24.82,,,,,,,,,,,,,,,,,,,Other,7.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.64,7.64, HYDRALAZINE HCL 20MG/ML INJ,J0360,HCPCS,636,RC,,1,ME,both,84.26,58.98,,,,,,,,,,,,,,,,,,,Other,18.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.3,18.17, hydrOXYzine HCL 50MG/1ML INJ (VISTARIL),250,RC,,,,1,ME,both,173.94,121.76,,,,,,,,,,,,,,,,,,,Other,37.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.5,37.5, predniSONE OPTH 1% 5ML SUSP (PRED-FORTE),637,RC,,,,1,ME,both,237.88,166.52,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, "HEPARIN 10,000units/ML INJ",J1644,HCPCS,636,RC,,1,UN,both,38.36,26.85,,,,,,,,,,,,,,,,,,,Other,8.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.18,8.27, PROMETHAZINE 25MG SUPP (PHENERGAN),250,RC,,,,1,ME,both,76.13,53.29,,,,,,,,,,,,,,,,,,,Other,16.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.42,16.42, HEPARIN LOCK 500UNIT/5ML FLUSH,J1642,HCPCS,250,RC,,1,ME,both,35.15,24.61,,,,,,,,,,,,,,,,,,,Other,7.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.02,7.58, HYDROCORTISONE 1% CRM (CORTIZONE),637,RC,,,,1,ME,both,27.6,19.32,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PAPAVERINE HCL 60MG/2ML 2ML INJ,250,RC,,,,1,ME,both,219.15,153.41,,,,,,,,,,,,,,,,,,,Other,47.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.25,47.25, HYDROCHLOROTHIAZIDE 25MG TAB,637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PAREGORIC LIQUID 5ML,250,RC,,,,1,ML,both,14.65,10.26,,,,,,,,,,,,,,,,,,,Other,3.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.16,3.16, PROTAMINE SULFATE 50MG/5ML INJ,J2720,HCPCS,636,RC,,1,ME,both,57.53,40.27,,,,,,,,,,,,,,,,,,,Other,12.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.54,12.41, PREDNISONE 1MG TAB,250,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,1.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.57,1.57, NITROGLYCERIN 0.2MG/HR PATCH (NITRO-DUR),637,RC,,,,1,EA,both,13.07,9.15,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, IMIPENEM/CILASTATIN 500MG INJ (PRIMAXIN),J0743,HCPCS,636,RC,,1,ME,both,171.23,119.86,,,,,,,,,,,,,,,,,,,Other,36.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.96,36.92, NICOTINE PATCH 7MG/DAY,250,RC,,,,1,ME,both,23.75,16.63,,,,,,,,,,,,,,,,,,,Other,5.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.13,5.13, "HEPARIN 1,000units/ML 1ML INJ",J1644,HCPCS,636,RC,,1,UN,both,42.71,29.9,,,,,,,,,,,,,,,,,,,Other,9.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.18,9.21, HEPARIN SODIUM INJ( 1MU/,J1644,HCPCS,636,RC,,1,UN,both,35.45,24.82,,,,,,,,,,,,,,,,,,,Other,7.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.18,7.64, PROCHLORPERAZINE 10MG/2ML INJ (COMPAZINE,J0780,HCPCS,636,RC,,1,ME,both,95.46,66.82,,,,,,,,,,,,,,,,,,,Other,20.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.47,20.58, PHENOBARB SOD INJ 130MG,250,RC,,,,1,ME,both,35.45,24.82,,,,,,,,,,,,,,,,,,,Other,7.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.64,7.64, NIFEdipineE XL 30 MG TAB (PROCARDIA XL),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, AMOXICILLIN 250MG CAP,637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, AZATHIOPRINE 50MG TAB (IMURAN),J7500,HCPCS,636,RC,,1,ME,both,9.07,6.35,,,,,,,,,,,,,,,,,,,Other,1.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.06,1.96, METOCLOPRAMIDE 10MG/2ML INJ (REGLAN),J2765,HCPCS,636,RC,,1,ME,both,35.15,24.61,,,,,,,,,,,,,,,,,,,Other,7.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.06,7.58, ISOPROTERENOL 1MG/5ML AMP (ISUPREL),250,RC,,,,1,ME,both,1217.78,852.45,,,,,,,,,,,,,,,,,,,Other,262.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,262.55,262.55, REFRESH PM LUB OPTH,250,RC,,,,1,EA,both,50.4,35.28,,,,,,,,,,,,,,,,,,,Other,10.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.87,10.87, LEVOTHYROXINE 0.025MG TAB (SYNTHROID),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ASPIRIN 81MG CHEW TAB,637,RC,,,,1,ME,both,6.95,4.87,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, WARFARIN 1MG TAB (COUMADIN),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, AMNIOCAPROIC ACID 250MG/ML INJ,J0281,HCPCS,636,RC,,1,ME,both,65.96,46.17,,,,,,,,,,,,,,,,,,,Other,14.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.56,14.22, VERAPAMIL SR 240MG TAB (ISOPTIN SR),637,RC,,,,1,ME,both,11.23,7.86,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PROPRANOLOL 1MG/1ML INJ (INDERAL),J1800,HCPCS,636,RC,,1,ME,both,35.45,24.82,,,,,,,,,,,,,,,,,,,Other,7.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.25,7.64, IBUPROFEN 400 MG TAB,637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, POLYMYXIN B/TRIMETHOPRIM OPHTH DROPS,250,RC,,,,1,EA,both,74.91,52.44,,,,,,,,,,,,,,,,,,,Other,16.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.15,16.15, MAGNESIUM SULFATE 1000MG/2ML INJ,J3475,HCPCS,636,RC,,1,ME,both,59.56,41.69,,,,,,,,,,,,,,,,,,,Other,12.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.39,12.84, SOD BICARB INJ:50MEQ 50ML,258,RC,,,,1,ML,both,35.45,24.82,,,,,,,,,,,,,,,,,,,Other,7.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.64,7.64, MELATONIN 5MG TAB,637,RC,,,,1,ME,both,6.64,4.65,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CARBAMAZEPINE 200MG TAB (TEGRETOL),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ALBUMIN 25% (12.5GM/50ML) INJ,P9047,HCPCS,636,RC,,1,ME,both,502.06,351.44,,,,,,,,,,,,,,,,,,,Other,108.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,52.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,52.02,108.24, FILGRASTIM 480MCG/0.8 ML INJ (NEUPOGEN),J1442,HCPCS,636,RC,,1,ME,both,2821.72,1975.2,,,,,,,,,,,,,,,,,,,Other,608.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.98,608.36, FENTANYL 1000MCG/20ML INJ (SUBLIMAZE),J3010,HCPCS,636,RC,,1,ME,both,144.11,100.88,,,,,,,,,,,,,,,,,,,Other,31.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.17,31.07, TIZANIDINE 4MG TAB (ZANAFLEX),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FACTOR 8 REC. 1127 U/VIAL,J7192,HCPCS,636,RC,,1,UN,both,7359.77,5151.84,,,,,,,,,,,,,,,,,,,Other,1586.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.56,1586.77, CALCIUM CHLORIDE 10% INJ 1000MG/10ML,250,RC,,,,1,ME,both,112.78,78.95,,,,,,,,,,,,,,,,,,,Other,24.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.31,24.31, LYMPHAZURIN 1% INJ 5ML(ISOSULFAN BLUE),Q9968,HCPCS,636,RC,,1,ML,both,6569.03,4598.32,,,,,,,,,,,,,,,,,,,Other,1416.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1416.29,1416.29, DILTIAZEM INJ 125MG/25ML,250,RC,,,,1,ME,both,113.31,79.32,,,,,,,,,,,,,,,,,,,Other,24.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.43,24.43, TOPIRAMATE 25MG TAB (TOPAMAX),637,RC,,,,1,ME,both,10.23,7.16,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, HEP B VAC RECOMB 20MCG/ML 1ML INJ,90746,HCPCS,636,RC,,1,EA,both,302.54,211.78,,,,,,,,,,,,,,,,,,,Other,65.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,73.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.23,73.64, HYDROCORTISONE 2.5% CRM (RECTAL USE),637,RC,,,,1,ME,both,375.52,262.86,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, LIOTHYRONINE 5MCG TAB,637,RC,,,,1,ME,both,6.39,4.47,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CALCIUM CARBONATE 500MG TAB (TUMS),637,RC,,,,1,ME,both,6.75,4.73,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, METOPROLOL XL SUCC 100MG (TOPROL XL),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NACL 3% 500ML HYPERTONIC SALINE IVF,J7131,HCPCS,636,RC,,1,ML,both,31.96,22.37,,,,,,,,,,,,,,,,,,,Other,6.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.89,6.89, PHENOL TOPICAL SWAB,250,RC,,,,1,EA,both,31.81,22.27,,,,,,,,,,,,,,,,,,,Other,6.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.86,6.86, NESIRITIDE 1.5MG INJ (NATRECOR),J2325,HCPCS,636,RC,,1,ME,both,2168.38,1517.87,,,,,,,,,,,,,,,,,,,Other,467.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,467.5,467.5, "HEPARIN 10,000units/10ML INJ",J1644,HCPCS,636,RC,,1,ME,both,31.96,22.37,,,,,,,,,,,,,,,,,,,Other,6.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.18,6.89, MOXIFLOXACIN 400MG TAB (AVELOX),637,RC,,,,1,ME,both,126.42,88.49,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ZIPRASIDONE 20MG CAP (GEODON),637,RC,,,,1,ME,both,39.15,27.41,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, LINEZOLID 600MG TAB (ZYVOX),637,RC,,,,1,ME,both,789.75,552.83,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, Linezolid PREMIX 600MG/300ML IVPB (ZYV,J2020,HCPCS,636,RC,,1,ME,both,473,331.1,,,,,,,,,,,,,,,,,,,Other,101.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.69,101.98, EPINEPH 1:1000 30MG/30ML INJ,J0169,HCPCS,250,RC,,1,ME,both,37.77,26.44,,,,,,,,,,,,,,,,,,,Other,8.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.35,8.14, ONDANSETRON ODT 4MG TAB (ZOFRAN ODT),Q0162,HCPCS,636,RC,,1,ME,both,107.45,75.22,,,,,,,,,,,,,,,,,,,Other,23.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.01,23.17, PODOPHYLLUM RESIN (PODOCON-25),250,RC,,,,1,ME,both,526.75,368.73,,,,,,,,,,,,,,,,,,,Other,113.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,113.57,113.57, PRAMIPEXOLE 0.25MG TAB (MIRAPEX),637,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, VANICREAM 16OZ JAR,250,RC,,,,1,ML,both,48.46,33.92,,,,,,,,,,,,,,,,,,,Other,10.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.45,10.45, TOLTERODINE ER 4MG CAP (DETROL),637,RC,,,,1,ME,both,15.98,11.19,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CEFAZOLIN 1000MG INJ (ANCEF),J0689,HCPCS,636,RC,,1,ME,both,35.95,25.17,,,,,,,,,,,,,,,,,,,Other,7.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.24,7.75, ZINC SULFATE 220MG CAP (EQUIV 50MG),637,RC,,,,1,ME,both,6.39,4.47,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PROMETHAZINE 25MG TAB (PHENERGAN),Q0169,HCPCS,636,RC,,1,ME,both,6.08,4.26,,,,,,,,,,,,,,,,,,,Other,1.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.04,1.31, SALINE NASAL GEL (AYR),637,RC,,,,1,EA,both,16.28,11.4,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, TRIMETHOBENZAMIDE 300MG CAP (TIGAN),Q0173,HCPCS,636,RC,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,1.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.49,1.49, PRIMIDONE 50MG TAB (MYSOLINE),637,RC,,,,1,ME,both,6.31,4.42,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, LUGOL'S SOLUTION,250,RC,,,,1,ML,both,68.85,48.2,,,,,,,,,,,,,,,,,,,Other,14.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.85,14.85, DESMOPRESSIN 4MCG/ML 1ML AMP (DDAVP),250,RC,,,,1,ME,both,1058.88,741.22,,,,,,,,,,,,,,,,,,,Other,228.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,228.29,228.29, NACL 7% 5ML NEB,J7131,HCPCS,636,RC,,1,ML,both,9.29,6.5,,,,,,,,,,,,,,,,,,,Other,2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2,2, FLORANEX TAB,637,RC,,,,1,EA,both,30.8,21.56,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DOCUSATE SODIUM 10MG/ML LIQ 120ML,250,RC,,,,1,ME,both,15.98,11.19,,,,,,,,,,,,,,,,,,,Other,3.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.45,3.45, CALCIUM GLUCONATE 1000MG/10ML,J0612,HCPCS,250,RC,,1,ME,both,167.86,117.5,,,,,,,,,,,,,,,,,,,Other,36.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.03,36.19, DOLASETRON 12.5MG INJ (ANZEMET),J1260,HCPCS,636,RC,,1,ME,both,71.46,50.02,,,,,,,,,,,,,,,,,,,Other,15.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.05,15.41, EMPTY IV CONTAINER 250ML,250,RC,,,,1,ML,both,18.8,13.16,,,,,,,,,,,,,,,,,,,Other,4.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.06,4.06, FENTANYL 100MCG/HR PATCH (DURAGESIC),250,RC,,,,1,ME,both,201.06,140.74,,,,,,,,,,,,,,,,,,,Other,43.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.35,43.35, CHARCOAL ACTIDOSE WITH SORBITOL (80Z),250,RC,,,,1,ML,both,89.48,62.64,,,,,,,,,,,,,,,,,,,Other,19.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.3,19.3, EMPTY STERILIZED VIAL 30ML,250,RC,,,,1,ML,both,4.15,2.91,,,,,,,,,,,,,,,,,,,Other,0.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.89,0.89, EPINEPHRINE 0.3MG/0.3ML AUTO PEN,J0169,HCPCS,250,RC,,1,ME,both,1074.72,752.3,,,,,,,,,,,,,,,,,,,Other,231.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.35,231.71, LIDOCAINE VISCOUS 15ML U/D (XYLOCAINE),637,RC,,,,1,ME,both,33.12,23.18,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ESMOLOL 2500MG/250ML PREMIX (BREVIBLOC),250,RC,,,,1,ME,both,2608.97,1826.28,,,,,,,,,,,,,,,,,,,Other,562.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,562.49,562.49, CHLORHEXIDINE ORAL RINSE (PERIDEX),250,RC,,,,1,ME,both,42.43,29.7,,,,,,,,,,,,,,,,,,,Other,9.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.14,9.14, GALANTAMINE 4MG TAB (RAZADYNE),637,RC,,,,1,ME,both,12.44,8.71,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ERTAPENEM 1000MG INJ (INVANZ),J1335,HCPCS,636,RC,,1,ME,both,653.05,457.14,,,,,,,,,,,,,,,,,,,Other,140.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.98,140.8, ALENDRONATE 70MG WEEKLY TAB (FOSAMAX),637,RC,,,,1,ME,both,84.63,59.24,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, GABAPENTIN 300MG CAP (NEURONTIN),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, TIOTROPIUM HANDIHALER (SPIRIVA),637,RC,,,,1,EA,both,523.27,366.29,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, QUETIAPINE 25MG TAB (SEROQUEL),637,RC,,,,1,ME,both,8.29,5.8,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, INFLUENZA ADULT VACCINE,90658,HCPCS,636,RC,,1,EA,both,76.19,53.33,,,,,,,,,,,,,,,,,,,Other,16.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,21.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.42,21.63, ACYCLOVIR 400MG TAB (ZOVIRAX),637,RC,,,,1,ME,both,16.11,11.28,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, cloNIDine 100MCG/ML 10ML VIAL (DURACLON),J0735,HCPCS,636,RC,,1,ME,both,265.76,186.03,,,,,,,,,,,,,,,,,,,Other,57.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.89,57.3, METOPROLOL 5MG/5ML INJ (LOPRESSOR),J3490,HCPCS,636,RC,,1,ME,both,29.64,20.75,,,,,,,,,,,,,,,,,,,Other,6.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.39,6.39, INSULIN GLARGINE PEN (LANTUS SOLOSTAR,J1815,HCPCS,636,RC,,1,EA,both,451.63,316.14,,,,,,,,,,,,,,,,,,,Other,97.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.88,97.37, VALPROATE SODIUM 500MG/5ML INJ,250,RC,,,,1,ME,both,34.28,24,,,,,,,,,,,,,,,,,,,Other,7.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.39,7.39, Fluconazole/PREMIX IVPB: 200MG/100ML,J1450,HCPCS,636,RC,,1,ME,both,99.09,69.36,,,,,,,,,,,,,,,,,,,Other,21.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.39,21.36, OXYBUTYNIN XL 5MG TAB (DITROPAN XL),637,RC,,,,1,ME,both,19.08,13.36,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, SUCRALFATE 1000MG/10ML (CARAFATE),250,RC,,,,1,ME,both,56.59,39.61,,,,,,,,,,,,,,,,,,,Other,12.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.2,12.2, LIDOCAINE 5% PATCH (LIDODERM),250,RC,,,,1,EA,both,136.77,95.74,,,,,,,,,,,,,,,,,,,Other,29.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,29.49,29.49, dexmedeTOMIDine 200MCG/2ML INJ,250,RC,,,,1,ME,both,330.93,231.65,,,,,,,,,,,,,,,,,,,Other,71.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.34,71.34, OXYCODONE CR 10MG TAB (OXYCONTIN),637,RC,,,,1,ME,both,8.29,5.8,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, OXYCODONE 5MG TAB,637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, "VITAMIN A 10,000U CAP",637,RC,,,,1,UN,both,4.06,2.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, POTASSIUM CHLORIDE 10MEQ TAB (KLOR CON),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ATROPINE 1MG/10ML INJ ABBOJECT,J0461,HCPCS,636,RC,,1,ME,both,70.02,49.01,,,,,,,,,,,,,,,,,,,Other,15.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.1,15.09, MULTIVITAMIN LIQUID 240ML,250,RC,,,,1,ML,both,25.44,17.81,,,,,,,,,,,,,,,,,,,Other,5.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.49,5.49, POLYETHYLENE GLYCOL 3350 17GM PKT (MIRAL,637,RC,,,,1,GM,both,13.96,9.77,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, VANCOMYCIN 125MG CAP (VANCOCIN),637,RC,,,,1,ME,both,134.61,94.23,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PHENYLEPHRINE 0.25% NASAL SPRAY (NEO-SYN,250,RC,,,,1,EA,both,15.39,10.77,,,,,,,,,,,,,,,,,,,Other,3.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.32,3.32, ACETAMINOPHEN W/CODEINE ORAL SOLN 5ML,637,RC,,,,1,ME,both,2.61,1.83,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PREGABALIN 25MG CAP (LYRICA),250,RC,,,,1,ME,both,37.3,26.11,,,,,,,,,,,,,,,,,,,Other,8.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.05,8.05, GUAIFENESIN 600MG TAB (MUCINEX),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PENTOXIFYLLINE 400MG TAB ER (TRENTAL),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, METRONIDAZOLE 500MG/100ML IVPB PREMIX,J1836,HCPCS,636,RC,,1,ME,both,36.61,25.63,,,,,,,,,,,,,,,,,,,Other,7.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.03,7.89, SLOW FE IRON,637,RC,,,,1,EA,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CHLORASEPTIC MUCOUS MEMBRANE SPRAY 1.4%,250,RC,,,,1,ME,both,24.04,16.83,,,,,,,,,,,,,,,,,,,Other,5.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.18,5.18, EZETIMIBE 10MG TAB (ZETIA),637,RC,,,,1,ME,both,53.28,37.3,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, BISMUTH 262MG CHEWABLE TAB,637,RC,,,,1,ME,both,6.75,4.73,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, HYDRALAZINE HCL 10MG TAB,J0360,HCPCS,637,RC,,1,ME,both,6.98,4.89,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.3,4.3, TRIPLE ANTIBIOTIC OINT 30GM TUBE (NEOSPO,637,RC,,,,1,ME,both,13.37,9.36,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ESTRIDIOL VAG CRM 42.5GM TUBE (ESTRACE),250,RC,,,,1,GM,both,223.71,156.6,,,,,,,,,,,,,,,,,,,Other,48.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,48.24,48.24, SENNA 8.6MG TAB (SENOKOT),250,RC,,,,1,ME,both,6.98,4.89,,,,,,,,,,,,,,,,,,,Other,1.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.51,1.51, DULOXETINE 30MG CAP (CYMBALTA),250,RC,,,,1,ME,both,34.07,23.85,,,,,,,,,,,,,,,,,,,Other,7.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.35,7.35, WARFARIN 5MG INJ (COUMADIN),250,RC,,,,1,ME,both,86.84,60.79,,,,,,,,,,,,,,,,,,,Other,18.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.72,18.72, FONDAPARINUX 2.5MG/0.5ML INJ (ARIXTRA),J1652,HCPCS,636,RC,,1,ME,both,173.15,121.21,,,,,,,,,,,,,,,,,,,Other,37.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.86,37.33, MORPHINE SULFATE CONC 20MG/ML 30ML,637,RC,,,,1,ME,both,108.36,75.85,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ZINC OXIDE 454GM OINT TUB,637,RC,,,,1,ME,both,62.46,43.72,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FLUTICASONE & SALMETEROL 250/50 DISKUS,637,RC,,,,1,EA,both,665.74,466.02,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, INSULIN ASPART PREFILLED PEN (NOVOLOG),250,RC,,,,1,UN,both,623.49,436.44,,,,,,,,,,,,,,,,,,,Other,134.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,134.43,134.43, INSULIN ASPART PROTAMINE/ASPART 70/30 PE,J1815,HCPCS,636,RC,,1,UN,both,593.44,415.41,,,,,,,,,,,,,,,,,,,Other,127.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.88,127.95, INSULIN DETEMIR PREFILLED PEN (LEVEMIR),J1815,HCPCS,636,RC,,1,UN,both,490.82,343.57,,,,,,,,,,,,,,,,,,,Other,105.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.88,105.82, CALCITRIOL 0.25 MCG LIQ CAP (ROCALTROL),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, STERILE WATER FOR INJECTION 1000 ML,250,RC,,,,1,ML,both,5.54,3.88,,,,,,,,,,,,,,,,,,,Other,1.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.2,1.2, AMOX/CLAVULANATE 200MG/28.5MG 50ML,637,RC,,,,1,ME,both,79.21,55.45,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PEDIALYTE 1000ML BOTTLE,637,RC,,,,1,ML,both,24.17,16.92,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FLUTICASONE & SALMETEROL 500/50 DISKUS,637,RC,,,,1,EA,both,1085.05,759.54,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, "EPOETIN ALPHA 20,000U (PROCRIT)",J0885,HCPCS,636,RC,,1,UN,both,2603.84,1822.69,,,,,,,,,,,,,,,,,,,Other,561.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.59,561.38, "EPOETIN ALPHA 10,000 U (PROCRIT)",J0885,HCPCS,636,RC,,1,UN,both,1702.8,1191.96,,,,,,,,,,,,,,,,,,,Other,367.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.59,367.13, CLOTRIMAZOLE 1% 30GM CRM (LOTRIMIN),250,RC,,,,1,GM,both,29.35,20.55,,,,,,,,,,,,,,,,,,,Other,6.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.33,6.33, B TOTAL LIQ 30 ML DROPPER BOTTLE,250,RC,,,,1,ML,both,31.25,21.88,,,,,,,,,,,,,,,,,,,Other,6.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.74,6.74, MOXIFLOXACIN 400MG/250ML PREMIX IVPB (AV,J2280,HCPCS,636,RC,,1,ME,both,140.91,98.64,,,,,,,,,,,,,,,,,,,Other,30.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.98,30.38, ACETAMINOPHEN 160MG/5ML U/D CUPS (TYLENO,637,RC,,,,1,ME,both,6.95,4.87,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, QUETIAPINE 100MG TAB (SEROQUEL),637,RC,,,,1,ME,both,15.76,11.03,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, MEMANTINE 5MG TAB (NAMENDA),637,RC,,,,1,ME,both,10.78,7.55,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, MENOMUNE-A/C/Y/W-135 INJ 0.05MG,250,RC,,,,1,ME,both,625.71,438,,,,,,,,,,,,,,,,,,,Other,134.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,134.91,134.91, PREGABALIN 50MG CAP (LYRICA),250,RC,,,,1,ME,both,42.39,29.67,,,,,,,,,,,,,,,,,,,Other,9.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.14,9.14, MEGESTROL 20MG TAB (MEGACE),J3475,HCPCS,636,RC,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,1.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.39,1.57, CARBOXYMETHYLCELLULOSE OPHTH DROP 15ML,637,RC,,,,1,ML,both,40.72,28.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, RANOLAZINE 500MG TAB (RANEXA),637,RC,,,,1,ME,both,16.57,11.6,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, BIVALIRUDIN 250MG INJ (ANGIOMAX),J0583,HCPCS,636,RC,,1,ME,both,1988.35,1391.85,,,,,,,,,,,,,,,,,,,Other,428.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.16,428.69, SOLIFENACIN 5MG TAB (VESICARE),637,RC,,,,1,ME,both,39.15,27.41,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PIOGLITAZONE 30MG TAB (ACTOS),637,RC,,,,1,ME,both,46.04,32.23,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, JUZO COMPRESSION STOCKINGS,250,RC,,,,1,EA,both,90.94,63.66,,,,,,,,,,,,,,,,,,,Other,19.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.61,19.61, CEPASTAT LOZENGE,250,RC,,,,1,EA,both,13.37,9.36,,,,,,,,,,,,,,,,,,,Other,2.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.88,2.88, HYDROcodone/APAP 7.5/325MG 15 ML ELIXIR,637,RC,,,,1,ME,both,14.93,10.45,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, HYDROMORPHONE 2MG TAB (DILAUDID),250,RC,,,,1,ME,both,6.98,4.89,,,,,,,,,,,,,,,,,,,Other,1.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.51,1.51, RIFAXIMIN 200MG TAB (XIFAXIN),250,RC,,,,1,ME,both,70.55,49.39,,,,,,,,,,,,,,,,,,,Other,15.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.21,15.21, OXYCODONE/APAP 5/325MG TAB (PERCOCET),637,RC,,,,1,ME,both,11.68,8.18,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, OSELTAMIVIR 75MG CAP (TAMIFLU),637,RC,,,,1,ME,both,71.86,50.3,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DEMECLOCYCLINE 150MG TAB,250,RC,,,,1,ME,both,47.04,32.93,,,,,,,,,,,,,,,,,,,Other,10.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.14,10.14, LEVETIRACETAM 500MG TAB (KEPPRA),637,RC,,,,1,ME,both,15.39,10.77,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, IBUPROFEN 100MG/5ML U/D CUP,637,RC,,,,1,ME,both,6.98,4.89,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ALTEPLASE 100MG INJ (ACTIVASE),J2997,HCPCS,636,RC,,1,ME,both,45509.85,31856.9,,,,,,,,,,,,,,,,,,,Other,9811.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,91.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,91.95,9811.93, FENTANYL 2500MCG/50ML INJ (SUBLIMAZE),J3010,HCPCS,636,RC,,1,ME,both,34,23.8,,,,,,,,,,,,,,,,,,,Other,7.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.17,7.33, AMMONIA INHALANTS,250,RC,,,,1,EA,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,1.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.7,1.7, AMMONIUM LACTATE 12% CRM (LAC-HYDRIN),250,RC,,,,1,EA,both,54.34,38.04,,,,,,,,,,,,,,,,,,,Other,11.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.71,11.71, COLLODION FLEXIBLE 5 ML,250,RC,,,,1,ML,both,445.57,311.9,,,,,,,,,,,,,,,,,,,Other,96.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,96.07,96.07, GLUCAGON 1MG INJ (GLUCAGEN),J1610,HCPCS,636,RC,,1,ME,both,1444.8,1011.36,,,,,,,,,,,,,,,,,,,Other,311.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,161.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,161.56,311.5, HYDROCORTISONE 500MG/4ML INJ (SOLU-CORTE,J1720,HCPCS,636,RC,,1,ME,both,61.59,43.11,,,,,,,,,,,,,,,,,,,Other,13.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,21.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.28,21.62, ZOLEDRONIC ACID 5MG/100ML PREMIX (RECLAS,J3489,HCPCS,636,RC,,1,ME,both,4669.25,3268.48,,,,,,,,,,,,,,,,,,,Other,1006.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.98,1006.7, LIDOCAINE-MPF 2% VIAL 5ML (XYLOCAINE-MPF,250,RC,,,,1,ML,both,27.93,19.55,,,,,,,,,,,,,,,,,,,Other,6.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.02,6.02, NEO/POLY/BACT OPHTH OINT (NESPORIN OPHTH,250,RC,,,,1,ME,both,25.57,17.9,,,,,,,,,,,,,,,,,,,Other,5.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.52,5.52, LUBIPROSTONE 24MCG CAP (AMITIZA),637,RC,,,,1,ME,both,16.28,11.4,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, HYDROCODONE/APAP TAB 10/325 MG (NORCO),637,RC,,,,1,ME,both,7.19,5.03,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, SEVOFLURANE INHALATION ANESTHETIC (ULTAN,250,RC,,,,1,EA,both,930.9,651.63,,,,,,,,,,,,,,,,,,,Other,200.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,200.7,200.7, VASELINE 2.5OZ TUBE,250,RC,,,,1,ML,both,8.13,5.69,,,,,,,,,,,,,,,,,,,Other,1.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.75,1.75, PROBIOTIC CAP,637,RC,,,,1,EA,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FENTANYL 12 MCG/HR PATCH (DURAGESIC),250,RC,,,,1,ME,both,94.37,66.06,,,,,,,,,,,,,,,,,,,Other,20.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.34,20.34, DICLOFENAC 1% 100GM TOPICAL GEL (VOLTAR,637,RC,,,,1,GM,both,268.23,187.76,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ASPIRIN & DIPYRIDAMOL 200MG CAP (AGGRENO,637,RC,,,,1,ME,both,10.78,7.55,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, OXCARBAZEPINE 150MG TAB (TRILEPTAL),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, MAGIC MOUTHWASH 120 ML,250,RC,,,,1,ML,both,609.78,426.85,,,,,,,,,,,,,,,,,,,Other,131.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,131.47,131.47, VENLAFAXINE XR 75MG CAP (EFFEXOR),250,RC,,,,1,ME,both,18.05,12.64,,,,,,,,,,,,,,,,,,,Other,3.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.89,3.89, AZITHROMYCIN 500MG INJ (ZITHROMAX),J0456,HCPCS,636,RC,,1,ME,both,79.32,55.52,,,,,,,,,,,,,,,,,,,Other,17.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2,17.1, IMMUNE GLOBULIN 5GM VIAL (GAMMAGARD S/D),250,RC,,,,1,ME,both,1711.89,1198.32,,,,,,,,,,,,,,,,,,,Other,369.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,369.09,369.09, ESCITALOPAM 10 MG TAB (LEXAPRO),250,RC,,,,1,ME,both,11.9,8.33,,,,,,,,,,,,,,,,,,,Other,2.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.57,2.57, PYRIDOXINE B6 25MG,637,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PROPOFOL 500MG/50ML INJ,J2704,HCPCS,250,RC,,1,ME,both,96.75,67.73,,,,,,,,,,,,,,,,,,,Other,20.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.09,20.86, MORPHINE SULFATE 4MG/ML INJ,J2270,HCPCS,636,RC,,1,ME,both,29.86,20.9,,,,,,,,,,,,,,,,,,,Other,6.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.98,6.44, PREDNISOLONE 15MG/5ML ELIXIR (PEDIAPRED),J7510,HCPCS,636,RC,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,1.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.9,1.49, VITAMIN D3 1000U (25MCG) TAB,637,RC,,,,1,UN,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FISH OIL 500MG CAP,250,RC,,,,1,ME,both,6.95,4.87,,,,,,,,,,,,,,,,,,,Other,1.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.5,1.5, METFORMIN ER 500MG TAB (GLUCOPHAGE XR),637,RC,,,,1,ME,both,7.26,5.08,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, VENLAFAXINE 75MG TAB (EFFEXOR),637,RC,,,,1,ME,both,9.68,6.78,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, BUDESONIDE & FORMOTEROL 160/4.5 INHALER,637,RC,,,,1,ME,both,1532.49,1072.74,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, GLYCERIN PEDIATRIC SUPPS,637,RC,,,,1,EA,both,6.75,4.73,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CHLORHEXIDINE GLUCONATE 4% SCRUB 8 OZ,250,RC,,,,1,ME,both,25.27,17.69,,,,,,,,,,,,,,,,,,,Other,5.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.45,5.45, KETOROLAC 15MG/1ML INJ (TORADOL),J1885,HCPCS,636,RC,,1,ME,both,29.86,20.9,,,,,,,,,,,,,,,,,,,Other,6.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.32,6.44, IPRATROPIUM/ALBUTEROL 3ML NEB (DUONEB),J7620,HCPCS,250,RC,,1,EA,both,10.27,7.19,,,,,,,,,,,,,,,,,,,Other,2.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.2,2.21, MIDODRINE 5MG TAB,A9270,HCPCS,637,RC,,1,ME,both,19.3,13.51,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NALOXONE 2MG/2ML SYR (NARCAN),J2312,HCPCS,250,RC,,1,ME,both,180.15,126.11,,,,,,,,,,,,,,,,,,,Other,38.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.06,38.84, LAMOTRIGINE 100MG TAB (LAMICTAL),637,RC,,,,1,ME,both,9.41,6.59,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, IRON SUCROSE 100MG/5ML INJ (VENOFER),J1756,HCPCS,636,RC,,1,ME,both,325.39,227.77,,,,,,,,,,,,,,,,,,,Other,70.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.24,70.16, VITAMIN D3 400U TAB,637,RC,,,,1,UN,both,6.75,4.73,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, LET SOLUTION,250,RC,,,,1,ML,both,35,24.5,,,,,,,,,,,,,,,,,,,Other,7.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.55,7.55, LIDOCAINE 2% W/EPI 20ML VIAL (XYLOCAINE,250,RC,,,,1,ML,both,81.12,56.78,,,,,,,,,,,,,,,,,,,Other,17.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.49,17.49, HALLS SF COUGH DROP,637,RC,,,,1,EA,both,6.09,4.26,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DEXTROMETHORPHAN COUGH SYRUP 3 OZ (DELSY,637,RC,,,,1,ME,both,42.13,29.49,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, METOPROLOL TART 25MG TAB (LOPRESSOR),637,RC,,,,1,ME,both,6.91,4.84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ALTEPLASE 2MG (CATHFLO ACTIVASE),J2997,HCPCS,636,RC,,1,ME,both,1003.28,702.3,,,,,,,,,,,,,,,,,,,Other,216.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,91.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,91.95,216.31, VALACYCLOVIR 1000MG TAB (VALTREX),637,RC,,,,1,ME,both,45.9,32.13,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, OSMOPREP TAB,637,RC,,,,1,EA,both,11.25,7.88,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ACETAMINOPHEN 325MG/10.15ML ELIXIR (TYLE,637,RC,,,,1,ME,both,6.98,4.89,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, INFLUENZA HIGH DOSE VACCINE,90653,HCPCS,636,RC,,1,EA,both,377.9,264.53,,,,,,,,,,,,,,,,,,,Other,81.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,96.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,81.48,96.2, ROPINIROLE 1MG TAB (REQUIP),637,RC,,,,1,ME,both,6.64,4.65,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CHLORTHALIDONE 25MG TAB (THALITONE),637,RC,,,,1,ME,both,9.87,6.91,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, "EPOETIN ALPHA 40,000 U (PROCRIT)",J0885,HCPCS,636,RC,,1,UN,both,4517.45,3162.22,,,,,,,,,,,,,,,,,,,Other,973.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.59,973.96, NYSTATIN 100MU/ML SUSP 5ML U/D CUP,637,RC,,,,1,UN,both,12.87,9.01,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, MUPIROCIN 15 GM CRM (BACTROBAN),637,RC,,,,1,ME,both,280.37,196.26,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CRANBERRY TABLETS 450MG,250,RC,,,,1,ME,both,6.95,4.87,,,,,,,,,,,,,,,,,,,Other,1.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.5,1.5, ACETAMINOPHEN PREMIX IVPB: 1000MG/100ML,J0131,HCPCS,636,RC,,1,ME,both,264.25,184.98,,,,,,,,,,,,,,,,,,,Other,56.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.06,56.98, ARIPIPRAZOLE 5MG TAB (ABILIFY),637,RC,,,,1,ME,both,148.76,104.13,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, MEPIVICAINE 2% 20ML INJ (CARBOCAINE),250,RC,,,,1,ML,both,31.81,22.27,,,,,,,,,,,,,,,,,,,Other,6.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.86,6.86, HYDROCODONE/APAP TAB 5/325MG (NORCO),637,RC,,,,1,ME,both,11.68,8.18,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DUTASTERIDE 0.5 MG CAP (AVODART),637,RC,,,,1,ME,both,18.25,12.78,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ERYTHROMYCIN 400MG/5ML SUSP (E.E.S),637,RC,,,,1,ME,both,122.76,85.93,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PHENYTOIN 100MG/2ML INJ (DILANTIN),J1165,HCPCS,636,RC,,1,ME,both,30.22,21.15,,,,,,,,,,,,,,,,,,,Other,6.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.59,6.52, MAGNESIUM SULFATE 5000MG/10ML INJ,J3475,HCPCS,636,RC,,1,ME,both,96.75,67.73,,,,,,,,,,,,,,,,,,,Other,20.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.39,20.86, MULTITRACE-4 MDV 10ML,250,RC,,,,1,ML,both,94.03,65.82,,,,,,,,,,,,,,,,,,,Other,20.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.28,20.28, CARVEDILOL 12.5 MG TAB (COREG),637,RC,,,,1,ME,both,9.95,6.97,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, DABIGATRAN 150 MG CAP (PRADAXA),637,RC,,,,1,ME,both,20.47,14.33,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, POTASSIUM CITRATE TAB 10MEQ (UROCIT K),637,RC,,,,1,ME,both,7.55,5.29,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, POLIDOCANOL 1% 2ML INJ (ASCLERA),250,RC,,,,1,ML,both,387.44,271.21,,,,,,,,,,,,,,,,,,,Other,83.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,83.54,83.54, INTRALIPID 20% 500ML,250,RC,,,,1,ML,both,284.01,198.81,,,,,,,,,,,,,,,,,,,Other,61.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.23,61.23, NACL 0.9% BACTERIOSTATIC 30ML VIAL,250,RC,,,,1,ML,both,28.76,20.13,,,,,,,,,,,,,,,,,,,Other,6.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.2,6.2, PREFILLED SYR 0.5ML TDaP (ADACEL),250,RC,,,,1,EA,both,216.46,151.52,,,,,,,,,,,,,,,,,,,Other,46.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,46.67,46.67, ACETYLCYSTEINE 6000MG/30ML INJ,J0132,HCPCS,636,RC,,1,ME,both,1032.6,722.82,,,,,,,,,,,,,,,,,,,Other,222.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.36,222.63, ONDANSETRON ODT 8MG TAB (ZOFRAN ODT),Q0162,HCPCS,636,RC,,1,ME,both,178.97,125.28,,,,,,,,,,,,,,,,,,,Other,38.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.01,38.58, FONDAPARINUX 5MG/0.4ML INJ (ARIXTRA),J1652,HCPCS,636,RC,,1,ME,both,587.48,411.24,,,,,,,,,,,,,,,,,,,Other,126.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.86,126.66, FONDAPARINUX 7.5MG/0.6ML INJ (ARIXTRA),J1652,HCPCS,636,RC,,1,ME,both,587.48,411.24,,,,,,,,,,,,,,,,,,,Other,126.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.86,126.66, LEVOTHYROXINE 100MCG INJ,250,RC,,,,1,ME,both,487.62,341.33,,,,,,,,,,,,,,,,,,,Other,105.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,105.13,105.13, VITAMIN A & D OINT 56.7GM TUBE,637,RC,,,,1,GM,both,10.74,7.52,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NACL 0.45% 250ML IV FLUID,250,RC,,,,1,ML,both,28.76,20.13,,,,,,,,,,,,,,,,,,,Other,6.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.2,6.2, ATORVASTATIN 40MG TAB (LIPITOR),637,RC,,,,1,ME,both,25.99,18.19,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ATORVASTATIN 10MG TAB (LIPITOR),637,RC,,,,1,ME,both,17.98,12.59,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, VITAMIN B-12 250 MCG TAB,637,RC,,,,1,ME,both,7.03,4.92,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, IBUPROFEN 800MG/200ML IVPB (CALDOLOR),J1741,HCPCS,636,RC,,1,ME,both,121.15,84.81,,,,,,,,,,,,,,,,,,,Other,26.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.12,26.12, HYDROCORTISONE 5MG TAB (CORTEF),637,RC,,,,1,ME,both,8.79,6.15,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, RIVAROXABAN 10MG (XARELTO),637,RC,,,,1,ME,both,84.71,59.3,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ENOXAPARIN SQ 40MG/0.4ML (LOVENOX),J1650,HCPCS,250,RC,,1,ME,both,155.43,108.8,,,,,,,,,,,,,,,,,,,Other,33.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.52,33.51, MELOXICAM 7.5MG TAB (MOBIC),637,RC,,,,1,ME,both,15.11,10.58,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, TRIMETHOPRIM 100MG TAB (PRIMSOL),637,RC,,,,1,ME,both,6.64,4.65,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, GENTAMICIN 40MG/ML 20ML VIAL,J1580,HCPCS,636,RC,,1,ME,both,150.78,105.55,,,,,,,,,,,,,,,,,,,Other,32.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.13,32.51, ENOXAPARIN SQ 30MG/0.3ML (LOVENOX),J1650,HCPCS,250,RC,,1,ME,both,129.58,90.71,,,,,,,,,,,,,,,,,,,Other,27.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.52,27.94, NM RENAL DOSE TC MAG3,A9562,HCPCS,343,RC,,1,EA,both,1700.26,1190.18,,,,,,,,,,,,,,,,,,,Other,366.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,366.58,366.58, NM HEPATOBILIARY DOSE CHO,A9537,HCPCS,343,RC,,1,EA,both,205.66,143.96,,,,,,,,,,,,,,,,,,,Other,44.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.34,44.34, NM MUGA DOSE PYP,A9560,HCPCS,343,RC,,1,EA,both,149.91,104.94,,,,,,,,,,,,,,,,,,,Other,32.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.32,32.32, NM CARDIOLITE DOSE TC,A9500,HCPCS,343,RC,,1,EA,both,332,232.4,,,,,,,,,,,,,,,,,,,Other,71.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.58,71.58, NM BONE DOSE TCMDP,A9503,HCPCS,343,RC,,1,EA,both,123.65,86.56,,,,,,,,,,,,,,,,,,,Other,26.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.66,26.66, NM TC99 FILTERED,A9520,HCPCS,343,RC,,1,EA,both,864.37,605.06,,,,,,,,,,,,,,,,,,,Other,186.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,186.36,186.36, NM Tc99m CERETEC,A9521,HCPCS,343,RC,,1,EA,both,2154.67,1508.27,,,,,,,,,,,,,,,,,,,Other,464.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,464.55,464.55, mitoMYcin 40MG VIAL,J9280,HCPCS,250,RC,,1,ME,both,5662.56,3963.79,,,,,,,,,,,,,,,,,,,Other,1220.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,25.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,25.58,1220.84, ENOXAPARIN SQ 100MG/ML (LOVENOX),250,RC,,,,1,ME,both,316.11,221.28,,,,,,,,,,,,,,,,,,,Other,68.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,68.15,68.15, CORICIDIN HBP COUGH & CONGESTION,637,RC,,,,1,EA,both,6.98,4.89,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NM IODINE 123,A9516,HCPCS,343,RC,,1,EA,both,326.56,228.59,,,,,,,,,,,,,,,,,,,Other,70.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,70.4,70.4, ARGATROBAN 125MG/125ML PREMIX,J0883,HCPCS,636,RC,,1,ME,both,3396.17,2377.32,,,,,,,,,,,,,,,,,,,Other,732.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.6,732.22, ACYCLOVIR 5% 15GM OINT (ZOVIRAX),250,RC,,,,1,GM,both,1714.84,1200.39,,,,,,,,,,,,,,,,,,,Other,369.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,369.71,369.71, ENOXAPARIN SQ 60MG/0.6ML (LOVENOX),J1650,HCPCS,636,RC,,1,ME,both,138.3,96.81,,,,,,,,,,,,,,,,,,,Other,29.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.52,29.82, AMIKACIN 1000MG/4ML INJ,J0278,HCPCS,636,RC,,1,ME,both,130.14,91.1,,,,,,,,,,,,,,,,,,,Other,28.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.61,28.06, NF-VIIBRYD ORAL TABLET 10MG,250,RC,,,,1,ME,both,20.97,14.68,,,,,,,,,,,,,,,,,,,Other,4.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.52,4.52, NIACIN ER 500MG TAB,250,RC,,,,1,ME,both,25.38,17.77,,,,,,,,,,,,,,,,,,,Other,5.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.47,5.47, NF-CLONAZEPAM ORAL TABLET 1MG,250,RC,,,,1,ME,both,7.52,5.26,,,,,,,,,,,,,,,,,,,Other,1.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.62,1.62, NF-MECLIZINE HCL ORAL TABLET 12.5MG,250,RC,,,,1,ME,both,3.29,2.3,,,,,,,,,,,,,,,,,,,Other,0.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.71,0.71, NF-CORDRAN SP TOPICAL CREAM 0.05%,250,RC,,,,1,EA,both,9.12,6.38,,,,,,,,,,,,,,,,,,,Other,1.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.97,1.97, NF-NEO AC ORAL SYRUP 10MG-30MG-15MG/5ML,250,RC,,,,1,ME,both,0.79,0.55,,,,,,,,,,,,,,,,,,,Other,0.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.17,0.17, NM Tc99m Pertechnetate Dose,A9512,HCPCS,343,RC,,1,EA,both,115.33,80.73,,,,,,,,,,,,,,,,,,,Other,24.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.86,24.86, REGADENOSON 0.4MG/5ML INJ,J2785,HCPCS,636,RC,,1,ME,both,1355.34,948.74,,,,,,,,,,,,,,,,,,,Other,292.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.63,292.21, NF-FEXOFENADINE HCL ORAL TABLET 180MG,250,RC,,,,1,ME,both,30.38,21.27,,,,,,,,,,,,,,,,,,,Other,6.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.55,6.55, HYDROMORPHONE 1MG/ML INJ,J1171,HCPCS,636,RC,,1,ME,both,27.83,19.48,,,,,,,,,,,,,,,,,,,Other,6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.14,6, NF-RISPERDAL ORAL TABLET 0.5MG,250,RC,,,,1,ME,both,21.23,14.86,,,,,,,,,,,,,,,,,,,Other,4.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.58,4.58, NF-LYRICA CAP 100MG,250,RC,,,,1,ME,both,16.24,11.37,,,,,,,,,,,,,,,,,,,Other,3.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.5,3.5, NF-ISOSORBIDE DINITRATE ORAL TABLET 30MG,250,RC,,,,1,ME,both,5.57,3.9,,,,,,,,,,,,,,,,,,,Other,1.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.21,1.21, NF-ISOSORBIDE MONONITRATE ORAL TAB ER 30,250,RC,,,,1,ME,both,2.96,2.07,,,,,,,,,,,,,,,,,,,Other,0.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.64,0.64, NF-RABEPRAZOLE SODIUM TAB EC 20MG,250,RC,,,,1,ME,both,41.06,28.74,,,,,,,,,,,,,,,,,,,Other,8.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.85,8.85, NF-CRESTOR TAB 10MG,250,RC,,,,1,ME,both,26.99,18.89,,,,,,,,,,,,,,,,,,,Other,5.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.82,5.82, NF-ESCITALOPRAM ORAL TABLET 20MG,250,RC,,,,1,ME,both,18.04,12.63,,,,,,,,,,,,,,,,,,,Other,3.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.89,3.89, NF-CITALOPRAM HBR ORAL TAB 40MG,250,RC,,,,1,ME,both,1.46,1.02,,,,,,,,,,,,,,,,,,,Other,0.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.31,0.31, NF-TRAZODONE HCL ORAL TABLET 100MG,250,RC,,,,1,ME,both,3.41,2.39,,,,,,,,,,,,,,,,,,,Other,0.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.74,0.74, DOBUTAMINE 250MG/250ML PREMIX,J1250,HCPCS,636,RC,,1,ME,both,79.09,55.36,,,,,,,,,,,,,,,,,,,Other,17.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.86,17.05, NF-LEVOTHYROXINE ORAL TABLET 0.2MG,250,RC,,,,1,ME,both,2.95,2.07,,,,,,,,,,,,,,,,,,,Other,0.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.64,0.64, NF-CLONAZEPAM DISINTEGRATING TAB 1MG,250,RC,,,,1,ME,both,6.55,4.59,,,,,,,,,,,,,,,,,,,Other,1.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.41,1.41, PROMETHAZINE 25MG/ML 1ML INJ (PHENERGAN,J2550,HCPCS,636,RC,,1,ME,both,28.48,19.94,,,,,,,,,,,,,,,,,,,Other,6.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.89,6.14, NF-NIFEDIPINE ER TABLET 90MG,250,RC,,,,1,ME,both,26.41,18.49,,,,,,,,,,,,,,,,,,,Other,5.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.69,5.69, DIAZEPAM 5 MG/ML 10 ML INJ,J3360,HCPCS,636,RC,,1,ME,both,88.12,61.68,,,,,,,,,,,,,,,,,,,Other,19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.56,19, TETANUS TOX/DIPHTH/PERTUS INJ (BOOSTRIX),90715,HCPCS,636,RC,,1,EA,both,268.5,187.95,,,,,,,,,,,,,,,,,,,Other,57.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,38.9,57.89, NF-DEMECLOCYCLINE HCL ORAL TABLET 300MG,250,RC,,,,1,ME,both,89.01,62.31,,,,,,,,,,,,,,,,,,,Other,19.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.19,19.19, PROPARACAINE 0.5% OPHTH DROP,250,RC,,,,1,EA,both,203.99,142.79,,,,,,,,,,,,,,,,,,,Other,43.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.98,43.98, TERAZOSIN 1 MG CAP (HYTRIN),250,RC,,,,1,ME,both,15.98,11.19,,,,,,,,,,,,,,,,,,,Other,3.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.45,3.45, NF-TERAZOSIN HCL CAP 2MG,250,RC,,,,1,ME,both,7.46,5.22,,,,,,,,,,,,,,,,,,,Other,1.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.61,1.61, NF-ICAPS ORIGINAL ORAL TABLET,250,RC,,,,1,ME,both,0.72,0.5,,,,,,,,,,,,,,,,,,,Other,0.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.16,0.16, TROPICAMIDE 1% OPHTH SOLN 15ml,250,RC,,,,1,EA,both,204.68,143.28,,,,,,,,,,,,,,,,,,,Other,44.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.13,44.13, NF-VOTRIENT TAB 200MG,250,RC,,,,1,ME,both,286.82,200.77,,,,,,,,,,,,,,,,,,,Other,61.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.84,61.84, NF-PRILOSEC CAP DR 40MG,250,RC,,,,1,ME,both,43.29,30.3,,,,,,,,,,,,,,,,,,,Other,9.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.33,9.33, NF-FERREX 150 FORTE CAP 25MCG-1MG-150MG,250,RC,,,,1,ME,both,1.28,0.9,,,,,,,,,,,,,,,,,,,Other,0.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.27,0.27, NF-PROCARDIA XL TABLET 60MG,250,RC,,,,1,ME,both,14.32,10.02,,,,,,,,,,,,,,,,,,,Other,3.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.09,3.09, NF-MEPROBAMATE ORAL TABLET 200MG,250,RC,,,,1,ME,both,6.19,4.33,,,,,,,,,,,,,,,,,,,Other,1.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.33,1.33, NF-PRAZOSIN HCL CAP 1MG,250,RC,,,,1,ME,both,2.22,1.55,,,,,,,,,,,,,,,,,,,Other,0.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.48,0.48, NF-OYSCO D TABLET 250MG-125IU,250,RC,,,,1,ME,both,0.04,0.03,,,,,,,,,,,,,,,,,,,Other,0.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.01,0.01, NF-OXAPROZIN ORAL TABLET 600MG,250,RC,,,,1,ME,both,6.79,4.75,,,,,,,,,,,,,,,,,,,Other,1.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.46,1.46, NF-PANTOPRAZOLE SODIUM ORAL TAB EC 40MG,250,RC,,,,1,ME,both,45.68,31.98,,,,,,,,,,,,,,,,,,,Other,9.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.85,9.85, NF-FELODIPINE TAB ER 10MG,250,RC,,,,1,ME,both,14.75,10.33,,,,,,,,,,,,,,,,,,,Other,3.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.18,3.18, ACYCLOVIR 1000MG/20ML INJ,J0133,HCPCS,636,RC,,1,ME,both,156.19,109.33,,,,,,,,,,,,,,,,,,,Other,33.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.12,33.67, CLINIMIX 5/20 1000 ML,258,RC,,,,1,ME,both,231.48,162.04,,,,,,,,,,,,,,,,,,,Other,49.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,49.91,49.91, BUPIVICAINE LIPOSOM 1.3% 20ML (EXPAREL),J0666,HCPCS,636,RC,,1,ML,both,2160.08,1512.06,,,,,,,,,,,,,,,,,,,Other,465.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.41,465.72, CLINIMIX 5/20 2000 ML,258,RC,,,,1,ML,both,420.68,294.48,,,,,,,,,,,,,,,,,,,Other,90.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,90.7,90.7, NF-VIMOVO TAB DR 20MG-500MG,250,RC,,,,1,ME,both,9.27,6.49,,,,,,,,,,,,,,,,,,,Other,2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2,2, NF-VERAPAMIL HCL CAP ER 120MG,250,RC,,,,1,ME,both,6.74,4.72,,,,,,,,,,,,,,,,,,,Other,1.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.45,1.45, NF-LOSARTAN POTASSIUM ORAL TABLET 25MG,250,RC,,,,1,ME,both,1.19,0.83,,,,,,,,,,,,,,,,,,,Other,0.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.25,0.25, NF-XARELTO ORAL TABLET 20MG,250,RC,,,,1,ME,both,41,28.7,,,,,,,,,,,,,,,,,,,Other,8.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.84,8.84, DONEPEZIL 5MG TAB (ARICEPT),250,RC,,,,1,ME,both,34.46,24.12,,,,,,,,,,,,,,,,,,,Other,7.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.43,7.43, NF-RIFAXIMIN TAB 550MG,250,RC,,,,1,ME,both,116.95,81.87,,,,,,,,,,,,,,,,,,,Other,25.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.22,25.22, NF-SPIRONOLACTONE ORAL TABLET 100MG,250,RC,,,,1,ME,both,6.22,4.35,,,,,,,,,,,,,,,,,,,Other,1.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.34,1.34, NF-METOCLOPRAMIDE HCL ORAL TABLET 5MG,250,RC,,,,1,ME,both,2.48,1.74,,,,,,,,,,,,,,,,,,,Other,0.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.54,0.54, SODIUM CITRATE & CITRIC ACID 15 ML SOLN,637,RC,,,,1,ML,both,6.63,4.64,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, SULFASALAZINE 500 MG TAB (AZULFADINE),637,RC,,,,1,ME,both,6.31,4.42,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-STALEVO 200 TAB 50MG-200MG-200MG,250,RC,,,,1,ME,both,23.37,16.36,,,,,,,,,,,,,,,,,,,Other,5.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.04,5.04, NF-NASONEX SPRAY 0.05MG/INH,250,RC,,,,1,ME,both,697.31,488.12,,,,,,,,,,,,,,,,,,,Other,150.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,150.34,150.34, NF-LOSARTAN-HCTZ ORAL TABLET 100MG-25MG,250,RC,,,,1,ME,both,15.85,11.1,,,,,,,,,,,,,,,,,,,Other,3.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.42,3.42, LIDOCAINE 2% TOPICAL 5 ML SYRINGE,250,RC,,,,1,ML,both,32.07,22.45,,,,,,,,,,,,,,,,,,,Other,6.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.92,6.92, SILODOSIN 8MG CAP (RAPAFLO),637,RC,,,,1,ME,both,24.95,17.47,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-PRAVACHOL ORAL TABLET 20MG,250,RC,,,,1,ME,both,20.36,14.25,,,,,,,,,,,,,,,,,,,Other,4.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.39,4.39, NF-LISINOPRIL AND HCTZ TABLET 20MG-25MG,250,RC,,,,1,ME,both,5.64,3.95,,,,,,,,,,,,,,,,,,,Other,1.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.22,1.22, NF-DIOVAN TAB 320MG,250,RC,,,,1,ME,both,26.97,18.88,,,,,,,,,,,,,,,,,,,Other,5.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.81,5.81, NF-HYDRALAZINE HCL ORAL TABLET 100MG,250,RC,,,,1,ME,both,4.7,3.29,,,,,,,,,,,,,,,,,,,Other,1.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.01,1.01, NF-RANITIDINE HCL CAPSULE 300MG,250,RC,,,,1,ME,both,12.74,8.92,,,,,,,,,,,,,,,,,,,Other,2.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.74,2.74, NF-POTASSIUM CHLORIDE CAP ER 10MEQ,250,RC,,,,1,ME,both,9.45,6.62,,,,,,,,,,,,,,,,,,,Other,2.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.04,2.04, NF-PREDNISONE ORAL TABLET 10MG,250,RC,,,,1,ME,both,1.57,1.1,,,,,,,,,,,,,,,,,,,Other,0.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.34,0.34, NF-HYDRALAZINE HCL ORAL TABLET 50MG,250,RC,,,,1,ME,both,2.21,1.55,,,,,,,,,,,,,,,,,,,Other,0.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.48,0.48, NF-PAROXETINE HCL ORAL TABLET 10MG,250,RC,,,,1,ME,both,11.77,8.24,,,,,,,,,,,,,,,,,,,Other,2.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.54,2.54, NF-LOSARTAN K AND HCTZ TABLET 100MG-25MG,250,RC,,,,1,ME,both,15.85,11.1,,,,,,,,,,,,,,,,,,,Other,3.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.42,3.42, NF-GABAPENTIN ORAL TABLET 600MG,250,RC,,,,1,ME,both,11.17,7.82,,,,,,,,,,,,,,,,,,,Other,2.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.41,2.41, NF-REMERON TAB 30MG,250,RC,,,,1,ME,both,22.97,16.08,,,,,,,,,,,,,,,,,,,Other,4.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.95,4.95, BAG BALM OINTMENT,637,RC,,,,1,EA,both,37.94,26.56,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-QUETIAPINE FUMARATE ORAL TABLET 50MG,250,RC,,,,1,ME,both,29.06,20.34,,,,,,,,,,,,,,,,,,,Other,6.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.26,6.26, NF-METHADONE HCL TAB 5MG,250,RC,,,,1,ME,both,1.14,0.8,,,,,,,,,,,,,,,,,,,Other,0.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.24,0.24, NF-GABAPENTIN CAP 400MG,250,RC,,,,1,ME,both,9.47,6.63,,,,,,,,,,,,,,,,,,,Other,2.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.04,2.04, NF-ASACOL HD TAB DR 800MG,250,RC,,,,1,ME,both,20.26,14.18,,,,,,,,,,,,,,,,,,,Other,4.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.37,4.37, NF-prednisoLONE ACETATE INJ SUSP 25MG/1M,250,RC,,,,1,ME,both,1.68,1.18,,,,,,,,,,,,,,,,,,,Other,0.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.36,0.36, NF-JANUVIA ORAL TABLET 100MG,250,RC,,,,1,ME,both,43.53,30.47,,,,,,,,,,,,,,,,,,,Other,9.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.39,9.39, NF-IMDUR TAB ER 30MG,250,RC,,,,1,ME,both,9.57,6.7,,,,,,,,,,,,,,,,,,,Other,2.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.07,2.07, NF-GLIMEPIRIDE ORAL TABLET 1MG,250,RC,,,,1,ME,both,1.78,1.25,,,,,,,,,,,,,,,,,,,Other,0.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.38,0.38, NF-LISINOPRIL AND HCTZ TABLET 10MG-12.5M,250,RC,,,,1,ME,both,5.16,3.61,,,,,,,,,,,,,,,,,,,Other,1.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.12,1.12, NF-LOSARTAN POTASSIUM ORAL TABLET 100MG,250,RC,,,,1,ME,both,13.63,9.54,,,,,,,,,,,,,,,,,,,Other,2.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.94,2.94, NF-PINDOLOL TABLET 10MG,250,RC,,,,1,ME,both,6.25,4.38,,,,,,,,,,,,,,,,,,,Other,1.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.35,1.35, NF-TRILIPIX CAP DR 135MG,250,RC,,,,1,ME,both,30.99,21.69,,,,,,,,,,,,,,,,,,,Other,6.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.68,6.68, NF-WELCHOL ORAL TABLET 625MG,250,RC,,,,1,ME,both,8.71,6.1,,,,,,,,,,,,,,,,,,,Other,1.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.88,1.88, NF-COMBIGAN OPHTH SOLN 0.2%-0.5%,250,RC,,,,1,EA,both,104.62,73.23,,,,,,,,,,,,,,,,,,,Other,22.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.56,22.56, NF-LUMIGAN OPHTH SOLN 0.01%,250,RC,,,,1,EA,both,233.62,163.53,,,,,,,,,,,,,,,,,,,Other,50.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,50.37,50.37, NF-HYDROcodone & HOMATROPINE SYR 5-1.5/5,250,RC,,,,1,ML,both,1.83,1.28,,,,,,,,,,,,,,,,,,,Other,0.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.39,0.39, NF-POLY VITAMIN LIQUID,250,RC,,,,1,ML,both,0.6,0.42,,,,,,,,,,,,,,,,,,,Other,0.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.13,0.13, NF-PRADAXA CAP 75MG,250,RC,,,,1,ME,both,22.15,15.51,,,,,,,,,,,,,,,,,,,Other,4.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.77,4.77, NF-ETODOLAC ORAL TABLET 400MG,250,RC,,,,1,ME,both,7.52,5.26,,,,,,,,,,,,,,,,,,,Other,1.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.62,1.62, NF-NITRO-DUR TD PATCH ER 0.1MG/1HR,250,RC,,,,1,EA,both,18.76,13.13,,,,,,,,,,,,,,,,,,,Other,4.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.05,4.05, NF-TEGRETOL-XR ORAL TAB ER 400MG,250,RC,,,,1,ME,both,14.86,10.4,,,,,,,,,,,,,,,,,,,Other,3.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.2,3.2, NF-NORCO TAB 325MG-7.5MG,250,RC,,,,1,ME,both,12.88,9.02,,,,,,,,,,,,,,,,,,,Other,2.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.77,2.77, CALCIUM GLUCONATE 500MG TAB,250,RC,,,,1,ME,both,6.31,4.42,,,,,,,,,,,,,,,,,,,Other,1.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.36,1.36, NF-LEVOTHYROXINE SODIUM ORAL TABLET 175M,250,RC,,,,1,ME,both,4.37,3.06,,,,,,,,,,,,,,,,,,,Other,0.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.94,0.94, NF-PRAVACHOL ORAL TABLET 40MG,250,RC,,,,1,ME,both,29.77,20.84,,,,,,,,,,,,,,,,,,,Other,6.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.42,6.42, NF-MELOXICAM ORAL TABLET 15MG,250,RC,,,,1,ME,both,21.43,15,,,,,,,,,,,,,,,,,,,Other,4.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.62,4.62, NF-VITAMIN D ORAL CAPSULE 5000IU,250,RC,,,,1,UN,both,0.55,0.39,,,,,,,,,,,,,,,,,,,Other,0.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.12,0.12, SUPREP BOWEL PREP KIT,250,RC,,,,1,EA,both,614.81,430.37,,,,,,,,,,,,,,,,,,,Other,132.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,132.55,132.55, "VITAMIN D 50,000IU CAP (ERGOCALIFEROL)",250,RC,,,,1,UN,both,8.26,5.78,,,,,,,,,,,,,,,,,,,Other,1.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.78,1.78, VITAMIN D3 5000U CAP,250,RC,,,,1,UN,both,6.63,4.64,,,,,,,,,,,,,,,,,,,Other,1.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.43,1.43, CALCIUM CITRATE 250 MG TAB,250,RC,,,,1,ME,both,6.31,4.42,,,,,,,,,,,,,,,,,,,Other,1.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.36,1.36, NF-DESMOPRESSIN ACETATE ORAL TABLET 0.2M,250,RC,,,,1,ME,both,17.47,12.23,,,,,,,,,,,,,,,,,,,Other,3.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.76,3.76, DESMOPRESSIN ACETATE 0.1MG TAB,250,RC,,,,1,ME,both,14.04,9.83,,,,,,,,,,,,,,,,,,,Other,3.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.03,3.03, NF-EPLERENONE ORAL TABLET 25MG,250,RC,,,,1,ME,both,18.15,12.71,,,,,,,,,,,,,,,,,,,Other,3.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.91,3.91, NF-ZIPRASIDONE HCL CAP 40MG,250,RC,,,,1,ME,both,55,38.5,,,,,,,,,,,,,,,,,,,Other,11.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.86,11.86, NF-PROCARBAZINE HCL CAP 50MG,250,RC,,,,1,ME,both,3.23,2.26,,,,,,,,,,,,,,,,,,,Other,0.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.7,0.7, NF-AMLODIPINE BESYLATE ORAL TABLET 2.5MG,250,RC,,,,1,ME,both,8.05,5.64,,,,,,,,,,,,,,,,,,,Other,1.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.73,1.73, NAPROXEN ORAL TABLET 220MG,250,RC,,,,1,ME,both,6.31,4.42,,,,,,,,,,,,,,,,,,,Other,1.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.36,1.36, NF-METFORMIN HCL ORAL TABLET 1000MG,250,RC,,,,1,ME,both,8.77,6.14,,,,,,,,,,,,,,,,,,,Other,1.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.89,1.89, NF-ENABLEX TAB ER 7.5MG,250,RC,,,,1,ME,both,40.32,28.22,,,,,,,,,,,,,,,,,,,Other,8.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.69,8.69, FIBERCON TAB 625MG,250,RC,,,,1,ME,both,7.47,5.23,,,,,,,,,,,,,,,,,,,Other,1.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.61,1.61, NF-FLUVASTATIN ORAL CAPSULE 20MG,250,RC,,,,1,ME,both,20.16,14.11,,,,,,,,,,,,,,,,,,,Other,4.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.35,4.35, NF-OMEPRAZOLE CAP DR 40MG,250,RC,,,,1,ME,both,27.61,19.33,,,,,,,,,,,,,,,,,,,Other,5.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.95,5.95, NF-FLOVENT HFA INH/NEB AER PWD 0.22MG/1A,250,RC,,,,1,EA,both,123.95,86.77,,,,,,,,,,,,,,,,,,,Other,26.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.72,26.72, NF-SEREVENT DISKUS DISK 0.046MG/ACT,250,RC,,,,1,EA,both,11.35,7.95,,,,,,,,,,,,,,,,,,,Other,2.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.45,2.45, NF-MIRAPEX ORAL TABLET 1.5MG,250,RC,,,,1,ME,both,10.35,7.25,,,,,,,,,,,,,,,,,,,Other,2.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.23,2.23, NF-LISINOPRIL ORAL TABLET 5MG,250,RC,,,,1,ME,both,2.12,1.48,,,,,,,,,,,,,,,,,,,Other,0.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.46,0.46, NF-NIFEDIPINE ORAL TAB ER 60MG,250,RC,,,,1,ME,both,10.44,7.31,,,,,,,,,,,,,,,,,,,Other,2.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.25,2.25, NF-PROTONIX ORAL TABLET 40MG,250,RC,,,,1,ME,both,20.24,14.17,,,,,,,,,,,,,,,,,,,Other,4.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.36,4.36, PRASUGREL 10MG TAB (EFFIENT),250,RC,,,,1,ME,both,43.97,30.78,,,,,,,,,,,,,,,,,,,Other,9.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.48,9.48, NF-LOVASTATIN ORAL TABLET 40MG,250,RC,,,,1,ME,both,17.43,12.2,,,,,,,,,,,,,,,,,,,Other,3.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.75,3.75, FENOFIBRATE 160MG TAB (TRICOR),637,RC,,,,1,ME,both,31.55,22.09,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, BUDESONIDE NEB 0.5MG/2ML(PULMICORT),J7626,HCPCS,250,RC,,1,ME,both,68.22,47.75,,,,,,,,,,,,,,,,,,,Other,14.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.03,14.71, NF-PROBENECID TAB 500MG,250,RC,,,,1,ME,both,5.58,3.91,,,,,,,,,,,,,,,,,,,Other,1.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.21,1.21, NF-HYDROXYZINE HCL ORAL TABLET 10MG,250,RC,,,,1,ME,both,2.9,2.03,,,,,,,,,,,,,,,,,,,Other,0.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.63,0.63, NF-HYDROCODONE AND APAP TAB 7.5MG-325MG,250,RC,,,,1,ME,both,2.88,2.02,,,,,,,,,,,,,,,,,,,Other,0.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.62,0.62, NF-METOPROLOL SUCCINATE ORAL TAB ER 25MG,250,RC,,,,1,ME,both,4.05,2.84,,,,,,,,,,,,,,,,,,,Other,0.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.87,0.87, NF-K-DUR TAB ER 20MEQ,250,RC,,,,1,ME,both,5,3.5,,,,,,,,,,,,,,,,,,,Other,1.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.08,1.08, LEVETIRACETAM 1000MG IVPB PREMIX,J1953,HCPCS,636,RC,,1,ME,both,254.4,178.08,,,,,,,,,,,,,,,,,,,Other,54.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.04,54.85, NF-LISINOPRIL ORAL TABLET 2.5MG,250,RC,,,,1,ME,both,3,2.1,,,,,,,,,,,,,,,,,,,Other,0.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.65,0.65, HYDROCODONE/APAP TAB 7.5/325MG(NORCO),637,RC,,,,1,ME,both,6.98,4.89,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FERUMOXYTOL 510MG/17ML INJ(FERAHEME),Q0138,HCPCS,636,RC,,1,ME,both,2857.84,2000.49,,,,,,,,,,,,,,,,,,,Other,616.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.35,616.15, GLIMEPERIDE 2MG TAB (AMARYL),250,RC,,,,1,ME,both,6.75,4.73,,,,,,,,,,,,,,,,,,,Other,1.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.46,1.46, NF-SIMVASTATIN ORAL TABLET 20MG,250,RC,,,,1,ME,both,21.77,15.24,,,,,,,,,,,,,,,,,,,Other,4.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.69,4.69, SITAGLIPTIN 50MG TAB (JANUVIA),637,RC,,,,1,ME,both,88.45,61.92,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-METOLAZONE ORAL TABLET 5MG,250,RC,,,,1,ME,both,6.67,4.67,,,,,,,,,,,,,,,,,,,Other,1.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.44,1.44, NF-POTASSIUM CHLORIDE ORAL TAB ER 20MEQ,250,RC,,,,1,ME,both,13.51,9.46,,,,,,,,,,,,,,,,,,,Other,2.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.91,2.91, LEVETIRACETAM 500MG PREMIX (KEPPRA),J1953,HCPCS,636,RC,,1,ME,both,152.6,106.82,,,,,,,,,,,,,,,,,,,Other,32.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.04,32.9, levETIRAcetam 100MG/ML ORAL SOLN 120ML,250,RC,,,,1,ME,both,399.75,279.83,,,,,,,,,,,,,,,,,,,Other,86.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,86.19,86.19, NF-TEMAZEPAM CAP 7.5MG,250,RC,,,,1,ME,both,38.13,26.69,,,,,,,,,,,,,,,,,,,Other,8.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.22,8.22, NF-MORPHINE SULFATE IR ORAL TABLET 15MG,250,RC,,,,1,ME,both,1.76,1.23,,,,,,,,,,,,,,,,,,,Other,0.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.38,0.38, AMIODARONE 450MG/9ML (50MG/ML)CORDARONE,J0282,HCPCS,636,RC,,1,ME,both,40.96,28.67,,,,,,,,,,,,,,,,,,,Other,8.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.4,8.83, levETIRAcetam 500MG/5ML 5ML INJ,J1953,HCPCS,636,RC,,1,ME,both,54.18,37.93,,,,,,,,,,,,,,,,,,,Other,11.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.04,11.68, ATORVASTATIN 20MG TAB (LIPITOR),637,RC,,,,1,ME,both,24.67,17.27,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-LEVAQUIN ORAL TABLET 750MG,250,RC,,,,1,ME,both,97.11,67.98,,,,,,,,,,,,,,,,,,,Other,20.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.93,20.93, NF-KETOROLAC TROMETHAMINE OPHTH SOLN 0.5,250,RC,,,,1,EA,both,85.02,59.51,,,,,,,,,,,,,,,,,,,Other,18.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.33,18.33, NF-KAYEXALATE PWD FOR SUSP,250,RC,,,,1,EA,both,5.95,4.17,,,,,,,,,,,,,,,,,,,Other,1.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.28,1.28, NF-PRAZOSIN HCL CAP 2MG,250,RC,,,,1,ME,both,4.23,2.96,,,,,,,,,,,,,,,,,,,Other,0.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.91,0.91, NEPHRO-VITE TAB,637,RC,,,,1,EA,both,6.68,4.68,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, POTASSIUM CHLORIDE/NS IVPB: 20MEQ/100ML,250,RC,,,,1,ME,both,28.48,19.94,,,,,,,,,,,,,,,,,,,Other,6.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.14,6.14, NF-CITALOPRAM ORAL TABLET 20MG,250,RC,,,,1,ME,both,8.44,5.91,,,,,,,,,,,,,,,,,,,Other,1.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.82,1.82, ACETYLCYSTEINE 20% INH RESP SOLN 4ML(MUC,J7608,HCPCS,250,RC,,1,EA,both,70.74,49.52,,,,,,,,,,,,,,,,,,,Other,15.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.29,15.25, NF-LISINOPRIL AND HCTZ TABLET 12.5MG-20M,250,RC,,,,1,ME,both,5.58,3.91,,,,,,,,,,,,,,,,,,,Other,1.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.21,1.21, NITROGLYCERIN 2% OINT 1 GM PKT(NITROBID),637,RC,,,,1,GM,both,14.59,10.21,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, TICAGRELOR 90MG TAB (BRILINTA),250,RC,,,,1,ME,both,38.8,27.16,,,,,,,,,,,,,,,,,,,Other,8.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.37,8.37, NF-CILOSTAZOL ORAL TABLET 50MG,250,RC,,,,1,ME,both,8.08,5.66,,,,,,,,,,,,,,,,,,,Other,1.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.74,1.74, NF-RAMIPRIL CAP 10MG,250,RC,,,,1,ME,both,12.93,9.05,,,,,,,,,,,,,,,,,,,Other,2.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.78,2.78, NF-CRESTOR TAB 20MG,250,RC,,,,1,ME,both,16.87,11.81,,,,,,,,,,,,,,,,,,,Other,3.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.64,3.64, NF-ISOSORBIDE DINITRATE ORAL TABLET 10MG,250,RC,,,,1,ME,both,4.57,3.2,,,,,,,,,,,,,,,,,,,Other,0.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.99,0.99, NF-GALANTAMINE HBR ORAL CAP ER 8MG,250,RC,,,,1,ME,both,28.38,19.87,,,,,,,,,,,,,,,,,,,Other,6.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.12,6.12, NF-METOCLOPRAMIDE HCL ORAL TABLET 10MG,250,RC,,,,1,ME,both,2.32,1.62,,,,,,,,,,,,,,,,,,,Other,0.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.5,0.5, NF-TIMOLOL MALEATE OPHTH SOLN 0.25%,250,RC,,,,1,ML,both,5.31,3.72,,,,,,,,,,,,,,,,,,,Other,1.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.15,1.15, NF-ALPHAGAN P OPHTH SOLN 0.1%,250,RC,,,,1,EA,both,101.5,71.05,,,,,,,,,,,,,,,,,,,Other,21.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,21.88,21.88, NF-DORZOLAMIDE HCL OPHTH SOLN 2%,250,RC,,,,1,EA,both,31.03,21.72,,,,,,,,,,,,,,,,,,,Other,6.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.69,6.69, CLARITHROMYCIN ORAL SUSP 250MG/5ML 50ML,250,RC,,,,1,ME,both,247.82,173.47,,,,,,,,,,,,,,,,,,,Other,53.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,53.43,53.43, NF-PROBENECID AND COLCHICINE 500MG-0.5MG,250,RC,,,,1,ME,both,76.37,53.46,,,,,,,,,,,,,,,,,,,Other,16.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.46,16.46, NF-LITHIUM CARBONATE CAP 600MG,250,RC,,,,1,ME,both,1.73,1.21,,,,,,,,,,,,,,,,,,,Other,0.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.37,0.37, NF-JALYN ORAL CAPSULE 0.5MG-0.4MG,250,RC,,,,1,ME,both,26.3,18.41,,,,,,,,,,,,,,,,,,,Other,5.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.67,5.67, NF-SIMVASTATIN ORAL TABLET 10MG,250,RC,,,,1,ME,both,2.4,1.68,,,,,,,,,,,,,,,,,,,Other,0.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.52,0.52, APIXABAN 2.5MG TABLET,250,RC,,,,1,ME,both,52.15,36.51,,,,,,,,,,,,,,,,,,,Other,11.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.24,11.24, NF-TRIAMTERENE AND HCTZ TABLET 75MG-50MG,250,RC,,,,1,ME,both,5.17,3.62,,,,,,,,,,,,,,,,,,,Other,1.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.12,1.12, NF-ZONISAMIDE CAP 50MG,250,RC,,,,1,ME,both,4.85,3.4,,,,,,,,,,,,,,,,,,,Other,1.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.05,1.05, NF-Zonisamide Oral Capsule 50MG,250,RC,,,,1,ME,both,3.31,2.32,,,,,,,,,,,,,,,,,,,Other,0.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.72,0.72, NF-DORZOLAMIDE HCL-TIMOLOL 22.3MG-6.8MG/,250,RC,,,,1,ME,both,57,39.9,,,,,,,,,,,,,,,,,,,Other,12.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.29,12.29, NF-PLAQUENIL TAB 200MG,250,RC,,,,1,ME,both,22.69,15.88,,,,,,,,,,,,,,,,,,,Other,4.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.89,4.89, NF-VITAMIN B COMPLEX ORAL TABLET,250,RC,,,,1,ME,both,0.44,0.31,,,,,,,,,,,,,,,,,,,Other,0.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.1,0.1, NF-GLUCOS-AMINE ORAL CAPSULE 500MG,250,RC,,,,1,ME,both,0.68,0.48,,,,,,,,,,,,,,,,,,,Other,0.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.15,0.15, NF-DOPamine HCl Injection 160MG/ML,250,RC,,,,1,ME,both,6.98,4.89,,,,,,,,,,,,,,,,,,,Other,1.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.51,1.51, NF-RisperDAL CONSTA IM PWD FOR SUSP ER 5,250,RC,,,,1,EA,both,3593.35,2515.35,,,,,,,,,,,,,,,,,,,Other,774.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,774.73,774.73, NF-NAMENDA XR ORAL CAPSULE ER 21MG,250,RC,,,,1,ME,both,55.21,38.65,,,,,,,,,,,,,,,,,,,Other,11.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.91,11.91, NF-QUETIAPINE FUMARATE ORAL TABLET 300MG,250,RC,,,,1,ME,both,75.06,52.54,,,,,,,,,,,,,,,,,,,Other,16.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.18,16.18, NF-SYSTANE BALANCE OPHTH SOLN 0.6%,250,RC,,,,1,EA,both,4.85,3.4,,,,,,,,,,,,,,,,,,,Other,1.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.05,1.05, NF-ELOCON CREAM 0.1%,250,RC,,,,1,EA,both,11.77,8.24,,,,,,,,,,,,,,,,,,,Other,2.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.54,2.54, NF-SYNTHROID ORAL TABLET 0.075MG,250,RC,,,,1,ME,both,2.97,2.08,,,,,,,,,,,,,,,,,,,Other,0.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.64,0.64, NF-SYNTHROID ORAL TABLET 0.1MG,250,RC,,,,1,ME,both,3.05,2.14,,,,,,,,,,,,,,,,,,,Other,0.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.66,0.66, NF-MEPROBAMATE ORAL TABLET 200MG,250,RC,,,,1,ME,both,30.42,21.29,,,,,,,,,,,,,,,,,,,Other,6.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.56,6.56, BIOTENE DRY MOUTH MOUTHWASH MM SOLUTI,250,RC,,,,1,ML,both,14.79,10.35,,,,,,,,,,,,,,,,,,,Other,3.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.18,3.18, NF-LIBRAX CAPSULE,250,RC,,,,1,EA,both,154.49,108.14,,,,,,,,,,,,,,,,,,,Other,33.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,33.31,33.31, NF-FENOFIBRATE ORAL TABLET 145MG,250,RC,,,,1,ME,both,20.6,14.42,,,,,,,,,,,,,,,,,,,Other,4.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.44,4.44, NF-TIMOLOL MALEATE OPHTH SOLN 0.5%,250,RC,,,,1,ME,both,207.08,144.96,,,,,,,,,,,,,,,,,,,Other,44.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,44.65,44.65, NF-TIMOLOL MALEATE OPHTH GEL DROP 0.5%,250,RC,,,,1,ME,both,152.58,106.81,,,,,,,,,,,,,,,,,,,Other,32.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.9,32.9, NF-Omeprazole Delayed-Release Capsule 40,250,RC,,,,1,ME,both,39.51,27.66,,,,,,,,,,,,,,,,,,,Other,8.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.52,8.52, NF-BUDESONIDE CAP DR 3MG,250,RC,,,,1,ME,both,87.61,61.33,,,,,,,,,,,,,,,,,,,Other,18.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.88,18.88, NF-METHIMAZOLE ORAL TABLET 5MG,250,RC,,,,1,ME,both,7.5,5.25,,,,,,,,,,,,,,,,,,,Other,1.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.62,1.62, NF-DUREZOL OPHTH EMUL 0.05%,250,RC,,,,1,EA,both,119.6,83.72,,,,,,,,,,,,,,,,,,,Other,25.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.78,25.78, NF-VASERETIC ORAL TABLET 10MG-25MG,250,RC,,,,1,ME,both,62.72,43.9,,,,,,,,,,,,,,,,,,,Other,13.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.52,13.52, NF-METHYLPHENIDATE ER ORAL TAB ER 20MG,250,RC,,,,1,ME,both,8.04,5.63,,,,,,,,,,,,,,,,,,,Other,1.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.73,1.73, NF-SIMBRINZA OPHTH SUSP 0.2%-1%,250,RC,,,,1,EA,both,77.33,54.13,,,,,,,,,,,,,,,,,,,Other,16.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.67,16.67, NF-SYSTANE OPHTH SOLUTION,250,RC,,,,1,ML,both,2.72,1.9,,,,,,,,,,,,,,,,,,,Other,0.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.59,0.59, NF-Pravastatin Sodium Oral Tablet 20MG,250,RC,,,,1,ME,both,3.48,2.44,,,,,,,,,,,,,,,,,,,Other,0.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.75,0.75, NF-NITRO-DUR TRANSDERM PATCH ER 0.6MG/1H,250,RC,,,,1,ME,both,27.52,19.26,,,,,,,,,,,,,,,,,,,Other,5.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.93,5.93, NF-MIRTAZAPINE ORAL TABLET 30MG,250,RC,,,,1,ME,both,5.7,3.99,,,,,,,,,,,,,,,,,,,Other,1.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.22,1.22, NF-GEODON CAP 40MG,250,RC,,,,1,ME,both,29.02,20.31,,,,,,,,,,,,,,,,,,,Other,6.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.25,6.25, NF-DILAUDID ORAL TABLET 4MG,250,RC,,,,1,ME,both,9.62,6.73,,,,,,,,,,,,,,,,,,,Other,2.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.08,2.08, NF-CURASOL HYDROGEL SATURATED,250,RC,,,,1,ME,both,22.36,15.65,,,,,,,,,,,,,,,,,,,Other,4.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.82,4.82, NF-SIMVASTATIN ORAL TABLET 40MG,250,RC,,,,1,ME,both,19.49,13.64,,,,,,,,,,,,,,,,,,,Other,4.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.2,4.2, NF-RAMIPRIL ORAL CAPSULE 2.5MG,250,RC,,,,1,ME,both,21.97,15.38,,,,,,,,,,,,,,,,,,,Other,4.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.73,4.73, NF-DEXILANT CAP DR 60MG,250,RC,,,,1,ME,both,37.57,26.3,,,,,,,,,,,,,,,,,,,Other,8.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.1,8.1, DAPTOMYCIN 500MG IV,J0878,HCPCS,636,RC,,1,ME,both,2485.16,1739.61,,,,,,,,,,,,,,,,,,,Other,535.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.03,535.81, NF-ROBAXIN-750 ORAL TABLET 750MG,250,RC,,,,1,ME,both,49.46,34.62,,,,,,,,,,,,,,,,,,,Other,10.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.66,10.66, NF-RENVELA ORAL TABLET 800MG,250,RC,,,,1,ME,both,24.8,17.36,,,,,,,,,,,,,,,,,,,Other,5.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.35,5.35, NF-MYCOPHENOLATE MOFETIL ORAL TABLET 500,250,RC,,,,1,ME,both,36.88,25.82,,,,,,,,,,,,,,,,,,,Other,7.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.95,7.95, NF-MYCOPHENOLATE MOFETIL CAP 250MG,250,RC,,,,1,ME,both,37.93,26.55,,,,,,,,,,,,,,,,,,,Other,8.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.17,8.17, NF-PROGRAF CAP 1MG,250,RC,,,,1,ME,both,23.13,16.19,,,,,,,,,,,,,,,,,,,Other,4.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.99,4.99, INJECTAFER IV SOLN 750MG/15ML,J1439,HCPCS,636,RC,,1,ML,both,4904.38,3433.07,,,,,,,,,,,,,,,,,,,Other,1057.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.1,1057.38, NF-CRESTOR TAB 5MG,250,RC,,,,1,ME,both,23.76,16.63,,,,,,,,,,,,,,,,,,,Other,5.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.13,5.13, NF-OCTREOTIDE ACETATE INJ SOLN 500MCG/1M,250,RC,,,,1,ME,both,195.25,136.68,,,,,,,,,,,,,,,,,,,Other,42.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.1,42.1, NF-PREVACID CAP DR 30MG,250,RC,,,,1,ME,both,100.96,70.67,,,,,,,,,,,,,,,,,,,Other,21.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,21.77,21.77, NF-TROSPIUM CHLORIDE ORAL TABLET 20MG,250,RC,,,,1,ME,both,12.55,8.79,,,,,,,,,,,,,,,,,,,Other,2.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.7,2.7, NF-METHYLCELLULOSE 1500 CPS POWDER,250,RC,,,,1,EA,both,5.93,4.15,,,,,,,,,,,,,,,,,,,Other,1.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.27,1.27, NF-CO Q-10 LIQUID CAPSULE 100MG,250,RC,,,,1,ME,both,2.04,1.43,,,,,,,,,,,,,,,,,,,Other,0.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.44,0.44, NF-VITAMIN B-12 SUBLINGUAL TABLET 1000MC,250,RC,,,,1,ME,both,0.59,0.41,,,,,,,,,,,,,,,,,,,Other,0.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.13,0.13, NF-CLONIDINE HCL TAB 0.3MG,250,RC,,,,1,ME,both,2.19,1.53,,,,,,,,,,,,,,,,,,,Other,0.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.47,0.47, NF-METOPROLOL TARTRATE 100MG TAB,250,RC,,,,1,ME,both,4.03,2.82,,,,,,,,,,,,,,,,,,,Other,0.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.87,0.87, NF-PHOSPHA 250 NEUTRAL ORAL TABLET,250,RC,,,,1,EA,both,2.36,1.65,,,,,,,,,,,,,,,,,,,Other,0.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.51,0.51, NF-NEXAVAR ORAL TABLET 200MG,250,RC,,,,1,ME,both,219.78,153.85,,,,,,,,,,,,,,,,,,,Other,47.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.38,47.38, NF-XIFAXAN ORAL TABLET 550MG,250,RC,,,,1,ME,both,148.78,104.15,,,,,,,,,,,,,,,,,,,Other,32.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.08,32.08, NF-OXYCODONE HCL ORAL TABLET 20MG,250,RC,,,,1,ME,both,5.12,3.58,,,,,,,,,,,,,,,,,,,Other,1.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.11,1.11, NF-SYNTHROID ORAL TABLET 75MCG,250,RC,,,,1,ME,both,5.36,3.75,,,,,,,,,,,,,,,,,,,Other,1.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.16,1.16, NF-RAMIPRIL CAP 10MG,250,RC,,,,1,ME,both,12.01,8.41,,,,,,,,,,,,,,,,,,,Other,2.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.59,2.59, ESZOPICLONE 1MG TAB,250,RC,,,,1,ME,both,19.66,13.76,,,,,,,,,,,,,,,,,,,Other,4.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.24,4.24, NF-VENLAFAXINE HCL CAP ER 150MG,250,RC,,,,1,ME,both,28.93,20.25,,,,,,,,,,,,,,,,,,,Other,6.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.23,6.23, SODIUM TETRADECYL 1% INJ 2ML,250,RC,,,,1,ML,both,403.13,282.19,,,,,,,,,,,,,,,,,,,Other,86.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,86.92,86.92, SODIUM PHOSPHATE 45MMOL/15ML INJ,250,RC,,,,1,ML,both,212.59,148.81,,,,,,,,,,,,,,,,,,,Other,45.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,45.83,45.83, TIGECYCLINE 50MG/10ML INJ,636,RC,,,,1,ME,both,664.76,465.33,,,,,,,,,,,,,,,,,,,Other,143.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,143.32,143.32, NF-HYDROCHLOROTHIAZIDE ORAL TABLET 50MG,250,RC,,,,1,ME,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-SIMVASTATIN ORAL TABLET 80MG,250,RC,,,,1,ME,both,21.77,15.24,,,,,,,,,,,,,,,,,,,Other,4.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.69,4.69, NF-PRESERVISION ORAL LIQUID CAPSULE,250,RC,,,,1,EA,both,1.23,0.86,,,,,,,,,,,,,,,,,,,Other,0.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.26,0.26, NF-LINZESS CAP 290MCG,250,RC,,,,1,ME,both,51.53,36.07,,,,,,,,,,,,,,,,,,,Other,11.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.11,11.11, NF-OXYCODONE HCL CAP 5MG,250,RC,,,,1,ME,both,8.55,5.99,,,,,,,,,,,,,,,,,,,Other,1.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.84,1.84, NF-OXYCODONE HCL ORAL TABLET 30MG,250,RC,,,,1,ME,both,8.98,6.29,,,,,,,,,,,,,,,,,,,Other,1.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.94,1.94, NF-NITROGLYCERIN SL SPRAY 0.4MG/1SPRAY,250,RC,,,,1,ME,both,313.19,219.23,,,,,,,,,,,,,,,,,,,Other,67.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,67.52,67.52, NF-MORPHINE SULFATE CAP ER 30MG,250,RC,,,,1,ME,both,27,18.9,,,,,,,,,,,,,,,,,,,Other,5.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.82,5.82, NF-TARCEVA TAB 150MG,250,RC,,,,1,ME,both,1187.41,831.19,,,,,,,,,,,,,,,,,,,Other,256.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,256.01,256.01, COLESTIPOL 1000mg TAB (COLESTID),250,RC,,,,1,ME,both,21.52,15.06,,,,,,,,,,,,,,,,,,,Other,4.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.64,4.64, ZADITOR OPHTH SOLN 0.025%,250,RC,,,,1,EA,both,56.67,39.67,,,,,,,,,,,,,,,,,,,Other,12.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.22,12.22, NF-PATADAY OPHTH SOLN 0.2%,250,RC,,,,1,EA,both,353,247.1,,,,,,,,,,,,,,,,,,,Other,76.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,76.11,76.11, NF-UCERIS ORAL EXTENDED RELEASE TABLET 9,250,RC,,,,1,ME,both,272.85,191,,,,,,,,,,,,,,,,,,,Other,58.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,58.83,58.83, NF-GLUCOSAMINE & CHONDR TAB 500MG-400MG,250,RC,,,,1,ME,both,5.73,4.01,,,,,,,,,,,,,,,,,,,Other,1.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.23,1.23, NF-MULTAQ ORAL TABLET 400MG,250,RC,,,,1,ME,both,41.59,29.11,,,,,,,,,,,,,,,,,,,Other,8.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.97,8.97, NF-VIACTIV CHEWABLE TABLET,250,RC,,,,1,EA,both,0.72,0.5,,,,,,,,,,,,,,,,,,,Other,0.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.16,0.16, NF-UCERIS ORAL EXTENDED RELEASE TABLET 9,250,RC,,,,1,EA,both,272.85,191,,,,,,,,,,,,,,,,,,,Other,58.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,58.83,58.83, NF-ERYTHROCIN STEARATE FILMTAB TAB 250MG,250,RC,,,,1,ME,both,1.87,1.31,,,,,,,,,,,,,,,,,,,Other,0.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.4,0.4, NF-SPIRONOLACTONE ORAL TAB 50MG,250,RC,,,,1,ME,both,3.6,2.52,,,,,,,,,,,,,,,,,,,Other,0.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.77,0.77, NF-SIMVASTATIN ORAL TABLET 20MG,250,RC,,,,1,ME,both,21.77,15.24,,,,,,,,,,,,,,,,,,,Other,4.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.69,4.69, NF-FENOFIBRATE ORAL TABLET 54MG,250,RC,,,,1,ME,both,9.15,6.41,,,,,,,,,,,,,,,,,,,Other,1.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.97,1.97, "NF-PNEUMOCOCCAL 13-VALENT VACCINE, DIPHT",90670,HCPCS,250,RC,,1,ME,both,1747.45,1223.22,,,,,,,,,,,,,,,,,,,Other,376.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,252.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,252.83,376.75, NF-NEXIUM CAP DR 40MG,250,RC,,,,1,ME,both,55.31,38.72,,,,,,,,,,,,,,,,,,,Other,11.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.93,11.93, PNEUMOCCAL VACCINE 13,90670,HCPCS,636,RC,,1,EA,both,1204.26,842.98,,,,,,,,,,,,,,,,,,,Other,259.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,252.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,252.83,259.64, MANNITOL 20% 500 ML,J2151,HCPCS,250,RC,,1,ML,both,340.54,238.38,,,,,,,,,,,,,,,,,,,Other,73.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.06,73.42, BCG INJ,90586,HCPCS,636,RC,,1,EA,both,770.72,539.5,,,,,,,,,,,,,,,,,,,Other,166.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,160.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,160.69,166.17, NF-PIOGLITAZONE ORAL TABLET 15MG,250,RC,,,,1,ME,both,30.99,21.69,,,,,,,,,,,,,,,,,,,Other,6.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.68,6.68, NF-VENLAFAXINE HYDROCHLORIDE CAP ER 150M,250,RC,,,,1,ME,both,2.4,1.68,,,,,,,,,,,,,,,,,,,Other,0.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.52,0.52, NF-ATORVASTATIN CALCIUM ORAL TAB 80MG,250,RC,,,,1,ME,both,47.69,33.38,,,,,,,,,,,,,,,,,,,Other,10.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.28,10.28, NF-QUETIAPINE FUMARATE ORAL TABLET 50MG,250,RC,,,,1,ME,both,29.06,20.34,,,,,,,,,,,,,,,,,,,Other,6.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.26,6.26, NF-WELLBUTRIN XL 24 HR TAB ER 150MG,250,RC,,,,1,ME,both,34.45,24.12,,,,,,,,,,,,,,,,,,,Other,7.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.43,7.43, NF-CYMBALTA CAP DR 60MG,250,RC,,,,1,ME,both,45.43,31.8,,,,,,,,,,,,,,,,,,,Other,9.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.79,9.79, CARB/LEVO ER TAB 50MG-200MG,250,RC,,,,1,ME,both,8.4,5.88,,,,,,,,,,,,,,,,,,,Other,1.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.81,1.81, NF-SYSTANE ULTRA OPHTHALMIC SOLN 0.4%-0.,250,RC,,,,1,EA,both,62.76,43.93,,,,,,,,,,,,,,,,,,,Other,13.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.53,13.53, NF-MOBIC ORAL TABLET 15MG,250,RC,,,,1,ME,both,18.1,12.67,,,,,,,,,,,,,,,,,,,Other,3.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.9,3.9, NF-TESTOSTERONE CYPIONATE IM OIL 200MG/1,250,RC,,,,1,ME,both,296.72,207.7,,,,,,,,,,,,,,,,,,,Other,63.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,63.97,63.97, NF-FLECAINIDE ACETATE TABLET 50MG,250,RC,,,,1,ME,both,8.94,6.26,,,,,,,,,,,,,,,,,,,Other,1.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.93,1.93, NF-GILOTRIF ORAL TABLET 40MG,250,RC,,,,1,ME,both,1145.73,802.01,,,,,,,,,,,,,,,,,,,Other,247.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,247.02,247.02, NF-VALSARTAN ORAL TABLET 320MG,250,RC,,,,1,ME,both,27.98,19.59,,,,,,,,,,,,,,,,,,,Other,6.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.04,6.04, NF-NITRO-DUR TRANSDERM PATCH ER 0.3MG/1H,250,RC,,,,1,ME,both,27.62,19.33,,,,,,,,,,,,,,,,,,,Other,5.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.96,5.96, TESTOSTERONE 200MG/ML INJ,J1072,HCPCS,250,RC,,1,ME,both,133.09,93.16,,,,,,,,,,,,,,,,,,,Other,28.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.29,28.69, NF-NAMENDA XR CAP ER 28MG,250,RC,,,,1,ME,both,59.91,41.94,,,,,,,,,,,,,,,,,,,Other,12.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.92,12.92, NF-NUEDEXTA CAP 20MG-10MG,250,RC,,,,1,ME,both,63.04,44.13,,,,,,,,,,,,,,,,,,,Other,13.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.59,13.59, NF-MIACALCIN NASAL SPRAY 200IU/ACT,250,RC,,,,1,UN,both,134.17,93.92,,,,,,,,,,,,,,,,,,,Other,28.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28.93,28.93, NF-HUMULIN N INJECTION 100U/ML,250,RC,,,,1,UN,both,67.28,47.1,,,,,,,,,,,,,,,,,,,Other,14.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.5,14.5, NF-RisperDAL Tablet 0.5MG,250,RC,,,,1,ME,both,42.99,30.09,,,,,,,,,,,,,,,,,,,Other,9.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.27,9.27, NF-hydrALAZINE HCl Oral Tablet 25,250,RC,,,,1,ME,both,2.32,1.62,,,,,,,,,,,,,,,,,,,Other,0.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.5,0.5, NF-Zofran Tablet 8MG,250,RC,,,,1,ME,both,195.8,137.06,,,,,,,,,,,,,,,,,,,Other,42.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.22,42.22, NF-TIMOLOL MALEATE OPHTH SOLN 0.5%,250,RC,,,,1,ML,both,17.83,12.48,,,,,,,,,,,,,,,,,,,Other,3.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.84,3.84, SUGAMMADEX 200MG/2ML INJ (BRIDION),250,RC,,,,1,ME,both,737.57,516.3,,,,,,,,,,,,,,,,,,,Other,159.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,159.02,159.02, NF-SENSIPAR ORAL TABLET 60MG,250,RC,,,,1,ME,both,226.61,158.63,,,,,,,,,,,,,,,,,,,Other,48.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,48.85,48.85, NF-CoQ10 In Oil Liquid Capsule 100MG-30I,250,RC,,,,1,ML,both,1.16,0.81,,,,,,,,,,,,,,,,,,,Other,0.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.25,0.25, NF-HYDROMORPHONE HCL ORAL TABLET 2MG,250,RC,,,,1,ME,both,1.89,1.32,,,,,,,,,,,,,,,,,,,Other,0.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.41,0.41, NF-TEARS NATURALE II OPHTH SOLUTION,250,RC,,,,1,EA,both,3.22,2.25,,,,,,,,,,,,,,,,,,,Other,0.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.7,0.7, NF-OMEPRAZOLE CAP DR 10MG,250,RC,,,,1,ME,both,17.2,12.04,,,,,,,,,,,,,,,,,,,Other,3.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.7,3.7, NF-RIVASTIGMINE TARTRATE CAP 6MG,250,RC,,,,1,ME,both,30.43,21.3,,,,,,,,,,,,,,,,,,,Other,6.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.56,6.56, NF-DILAUDID ORAL TABLET 4MG,250,RC,,,,1,ME,both,7.18,5.03,,,,,,,,,,,,,,,,,,,Other,1.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.55,1.55, humaLOG MIX 75/25 INJECTION,250,RC,,,,1,UN,both,137.01,95.91,,,,,,,,,,,,,,,,,,,Other,29.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,29.54,29.54, SULFAMETH/TMP SUSP 800/160/20ML,250,RC,,,,1,ME,both,22.96,16.07,,,,,,,,,,,,,,,,,,,Other,4.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.95,4.95, TRANEXAMIC ACID 1000MG/10ML INJ,250,RC,,,,1,ME,both,290.55,203.39,,,,,,,,,,,,,,,,,,,Other,62.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,62.64,62.64, NF-SIMVASTATIN ORAL TABLET 10MG,250,RC,,,,1,ME,both,12.41,8.69,,,,,,,,,,,,,,,,,,,Other,2.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.68,2.68, NF-DICLOFENAC SODIUM ORAL TAB EC 50MG,250,RC,,,,1,ME,both,5.89,4.12,,,,,,,,,,,,,,,,,,,Other,1.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.27,1.27, NF-DICLOFENAC SODIUM ORAL TAB ER 100MG,250,RC,,,,1,ME,both,35.21,24.65,,,,,,,,,,,,,,,,,,,Other,7.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.6,7.6, NF-humaLOG MIX 75/25 INJECTION,250,RC,,,,1,ME,both,128.75,90.13,,,,,,,,,,,,,,,,,,,Other,27.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,27.76,27.76, NF-SANCTURA XR CAP ER 60MG,250,RC,,,,1,ME,both,28.73,20.11,,,,,,,,,,,,,,,,,,,Other,6.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.19,6.19, NF-LEVSIN SL TAB 0.125MG,250,RC,,,,1,ME,both,4.49,3.14,,,,,,,,,,,,,,,,,,,Other,0.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.97,0.97, NF-LEVSIN SL TAB 0.125MG,250,RC,,,,1,ME,both,4.49,3.14,,,,,,,,,,,,,,,,,,,Other,0.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.97,0.97, NF-DIOVAN HCT ORAL TABLET 160MG-12.5MG,250,RC,,,,1,ME,both,31.69,22.18,,,,,,,,,,,,,,,,,,,Other,6.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.83,6.83, NF-DIOVAN HCT ORAL TABLET 320MG-25MG,250,RC,,,,1,ME,both,55.63,38.94,,,,,,,,,,,,,,,,,,,Other,12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12,12, NF-ENALAPRIL MALEATE ORAL TABLET 20MG,250,RC,,,,1,ME,both,11.14,7.8,,,,,,,,,,,,,,,,,,,Other,2.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.4,2.4, NF-NICOTINE TD PATCH ER 14MG/24HR,250,RC,,,,1,EA,both,9.91,6.94,,,,,,,,,,,,,,,,,,,Other,2.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.14,2.14, NF-LEVOTHYROXINE SODIUM ORAL TABLET 137M,250,RC,,,,1,ME,both,7.85,5.5,,,,,,,,,,,,,,,,,,,Other,1.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.7,1.7, NF-LEVOBUNOLOL HCL OPHTH SOLN 0.5%,250,RC,,,,1,EA,both,14.91,10.44,,,,,,,,,,,,,,,,,,,Other,3.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.21,3.21, NF-ZIAC ORAL TABLET 2.5MG-6.25MG,250,RC,,,,1,ME,both,6.31,4.42,,,,,,,,,,,,,,,,,,,Other,1.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.36,1.36, NF-LATANOPROST OPHTH SOLN 0.005%,250,RC,,,,1,EA,both,213.65,149.56,,,,,,,,,,,,,,,,,,,Other,46.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,46.06,46.06, NF-LATANOPROST OPHTH SOLN 0.005%,250,RC,,,,1,ML,both,213.65,149.56,,,,,,,,,,,,,,,,,,,Other,46.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,46.06,46.06, NF-Rocaltrol Liquid Filled Capsule 0.5MC,250,RC,,,,1,EA,both,11.63,8.14,,,,,,,,,,,,,,,,,,,Other,2.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.51,2.51, NF-Metadate CD Capsule ER 20MG,250,RC,,,,1,ME,both,11.63,8.14,,,,,,,,,,,,,,,,,,,Other,2.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.51,2.51, NOZIN NASAL SANITIZER AMP,637,RC,,,,1,EA,both,9.49,6.64,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-HYDROXYZINE HCL ORAL TAB 10MG,250,RC,,,,1,ME,both,3.75,2.63,,,,,,,,,,,,,,,,,,,Other,0.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.81,0.81, NF-HYDROXYZINE HCL ORAL TABLET 10MG,250,RC,,,,1,ME,both,4.16,2.91,,,,,,,,,,,,,,,,,,,Other,0.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.9,0.9, NF-LOTREL CAP 5MG-20MG,250,RC,,,,1,ME,both,25.45,17.82,,,,,,,,,,,,,,,,,,,Other,5.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.49,5.49, NF-CRESTOR ORAL TABLET 40MG,250,RC,,,,1,ME,both,24.54,17.18,,,,,,,,,,,,,,,,,,,Other,5.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.29,5.29, NF-Citalopram Oral Tablet 20MG,250,RC,,,,1,ME,both,11.06,7.74,,,,,,,,,,,,,,,,,,,Other,2.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.38,2.38, NF-LITHIUM CARBONATE ORAL TAB ER 450MG,250,RC,,,,1,ME,both,2.15,1.51,,,,,,,,,,,,,,,,,,,Other,0.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.46,0.46, NF-DALIRESP ORAL TABLET 500MCG,250,RC,,,,1,ME,both,54.88,38.42,,,,,,,,,,,,,,,,,,,Other,11.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.83,11.83, NF-CITRUCEL FIBER ORAL PWD FOR SUSP 2GM,250,RC,,,,1,ME,both,0.16,0.11,,,,,,,,,,,,,,,,,,,Other,0.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.04,0.04, NF-MORPHINE SULFATE TAB IR 30MG,250,RC,,,,1,ME,both,3.22,2.25,,,,,,,,,,,,,,,,,,,Other,0.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.7,0.7, NF-DICLOFENAC SODIUM OPHTH SOLN 0.1%,250,RC,,,,1,EA,both,16.28,11.4,,,,,,,,,,,,,,,,,,,Other,3.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.51,3.51, PANTOPRAZOLE 40MG INJ (PROTONIX),250,RC,,,,1,ME,both,39.51,27.66,,,,,,,,,,,,,,,,,,,Other,8.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.52,8.52, NF-JAKAFI ORAL TABLET 15MG,250,RC,,,,1,ME,both,936.8,655.76,,,,,,,,,,,,,,,,,,,Other,201.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,201.98,201.98, NF-WELLBUTRIN TAB 100MG,250,RC,,,,1,ME,both,17.27,12.09,,,,,,,,,,,,,,,,,,,Other,3.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.72,3.72, NF-Tekturna Oral Tablet 300MG,250,RC,,,,1,ME,both,33.19,23.23,,,,,,,,,,,,,,,,,,,Other,7.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.15,7.15, NF-TRAVATAN Z OPHTH SOLN 0.004%,250,RC,,,,1,EA,both,334.49,234.14,,,,,,,,,,,,,,,,,,,Other,72.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,72.12,72.12, NF-ARMOUR THYROID TABLET 60MG,250,RC,,,,1,ME,both,3.23,2.26,,,,,,,,,,,,,,,,,,,Other,0.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.7,0.7, NF-EYE VITAMINS AND MINERALS ORAL TABLET,250,RC,,,,1,ME,both,0.21,0.15,,,,,,,,,,,,,,,,,,,Other,0.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.05,0.05, NF-PINDOLOL ORAL TABLET 10MG,250,RC,,,,1,ME,both,6.63,4.64,,,,,,,,,,,,,,,,,,,Other,1.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.43,1.43, NF-OXYCODONE HCL-ACETAMINOPHEN ORAL TABL,250,RC,,,,1,EA,both,16.49,11.54,,,,,,,,,,,,,,,,,,,Other,3.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.56,3.56, NF-LAMICTAL XR EXTENDED RELEASE TAB 200M,250,RC,,,,1,ME,both,121.39,84.97,,,,,,,,,,,,,,,,,,,Other,26.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.18,26.18, NF-CHROMIUM ORAL TABLET 200MCG,250,RC,,,,1,ME,both,0.12,0.08,,,,,,,,,,,,,,,,,,,Other,0.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.03,0.03, NF-FEMARA TAB 2.5MG,250,RC,,,,1,ME,both,130.54,91.38,,,,,,,,,,,,,,,,,,,Other,28.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28.15,28.15, NF-BENICAR ORAL TABLET 40MG,250,RC,,,,1,ME,both,42.95,30.07,,,,,,,,,,,,,,,,,,,Other,9.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.26,9.26, NF-FLORAJEN3 ORAL CAPSULE,250,RC,,,,1,ME,both,2.32,1.62,,,,,,,,,,,,,,,,,,,Other,0.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.5,0.5, EDRPHONIUM INJ SOLUTION 10MG/1ML-15ML,250,RC,,,,1,ME,both,446.28,312.4,,,,,,,,,,,,,,,,,,,Other,96.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,96.22,96.22, NF-PYRIDOSTIGMINE BROMIDE TAB 60MG,250,RC,,,,1,ME,both,3.71,2.6,,,,,,,,,,,,,,,,,,,Other,0.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.8,0.8, NF-MICARDIS HCT TAB 40MG-12.5MG,250,RC,,,,1,ME,both,33.05,23.14,,,,,,,,,,,,,,,,,,,Other,7.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.12,7.12, NF-MICARDIS ORAL TABLET 40MG,250,RC,,,,1,ME,both,9.47,6.63,,,,,,,,,,,,,,,,,,,Other,2.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.04,2.04, NF-PRAVASTATIN SODIUM ORAL TABLET 10MG,250,RC,,,,1,ME,both,14.94,10.46,,,,,,,,,,,,,,,,,,,Other,3.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.22,3.22, NF-Pataday Ophthalmic Solution 0.2%,250,RC,,,,1,ML,both,352.13,246.49,,,,,,,,,,,,,,,,,,,Other,75.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,75.92,75.92, NF-SENNA PLUS ORAL TABLET 50MG-8.6MG,250,RC,,,,1,ME,both,0.59,0.41,,,,,,,,,,,,,,,,,,,Other,0.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.13,0.13, NF-HYDROMORPHONE HCL ORAL TABLET 4MG,250,RC,,,,1,ME,both,2.85,2,,,,,,,,,,,,,,,,,,,Other,0.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.62,0.62, NF-RISPERDAL CONSTA IM PWD FOR SUSP ER 2,250,RC,,,,1,EA,both,2214.63,1550.24,,,,,,,,,,,,,,,,,,,Other,477.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,477.48,477.48, NF-SERTRALINE HCL ORAL TABLET 100MG,250,RC,,,,1,ME,both,10.18,7.13,,,,,,,,,,,,,,,,,,,Other,2.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.2,2.2, NF-LATUDA ORAL TABLET 120MG,250,RC,,,,1,ME,both,243.55,170.49,,,,,,,,,,,,,,,,,,,Other,52.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,52.51,52.51, NF-LEFLUNOMIDE ORAL TABLET 20MG,250,RC,,,,1,ME,both,19.85,13.9,,,,,,,,,,,,,,,,,,,Other,4.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.28,4.28, NF-EFFEXOR XR ORAL CAP ER 37.5MG,250,RC,,,,1,ME,both,20.81,14.57,,,,,,,,,,,,,,,,,,,Other,4.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.49,4.49, NF-SIMBRINZA OPHTH SUSP 0.2%-1%,250,RC,,,,1,ML,both,91.91,64.34,,,,,,,,,,,,,,,,,,,Other,19.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.82,19.82, NF-ZOCOR ORAL TABLET 20MG,250,RC,,,,1,ME,both,28.44,19.91,,,,,,,,,,,,,,,,,,,Other,6.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.13,6.13, ATROPINE SULF EYE DROPS 1% 5ML,250,RC,,,,1,EA,both,271.39,189.97,,,,,,,,,,,,,,,,,,,Other,58.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,58.52,58.52, NF-ZOCOR ORAL TABLET 10MG,250,RC,,,,1,ME,both,23.15,16.21,,,,,,,,,,,,,,,,,,,Other,4.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.99,4.99, NF-REVATIO TAB 20MG,250,RC,,,,1,ME,both,193.21,135.25,,,,,,,,,,,,,,,,,,,Other,41.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.66,41.66, NF-RENVELA ORAL TABLET 800MG,250,RC,,,,1,ME,both,29.96,20.97,,,,,,,,,,,,,,,,,,,Other,6.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.46,6.46, NF-CLOBETASOL PROPIONATE CREAM 0.05%,250,RC,,,,1,EA,both,39.73,27.81,,,,,,,,,,,,,,,,,,,Other,8.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.57,8.57, NF-TERCONAZOLE VAG CRM 0.4%,250,RC,,,,1,EA,both,4.45,3.12,,,,,,,,,,,,,,,,,,,Other,0.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.96,0.96, NF-FELODIPINE EXTENDED-RELEASE TABLET 10,250,RC,,,,1,ME,both,12.62,8.83,,,,,,,,,,,,,,,,,,,Other,2.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.72,2.72, NF-URSODIOL TAB 500MG,250,RC,,,,1,ME,both,21.03,14.72,,,,,,,,,,,,,,,,,,,Other,4.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.54,4.54, NF-RIFAXIMIN TAB 200MG,250,RC,,,,1,ME,both,51.49,36.04,,,,,,,,,,,,,,,,,,,Other,11.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.1,11.1, NF-XIFAXAN ORAL TABLET 550MG,250,RC,,,,1,ME,both,118.62,83.03,,,,,,,,,,,,,,,,,,,Other,25.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.58,25.58, NF-LOVASTATIN ORAL TABLET 20MG,250,RC,,,,1,ME,both,7.19,5.03,,,,,,,,,,,,,,,,,,,Other,1.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.55,1.55, NF-URSODIOL ORAL TABLET 500MG,250,RC,,,,1,ME,both,21.03,14.72,,,,,,,,,,,,,,,,,,,Other,4.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.54,4.54, NF-XIFAXAN ORAL TABLET 550MG,250,RC,,,,1,ME,both,162.16,113.51,,,,,,,,,,,,,,,,,,,Other,34.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.97,34.97, NF-ISONIAZID ORAL TABLET 300MG,250,RC,,,,1,ME,both,3.71,2.6,,,,,,,,,,,,,,,,,,,Other,0.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.8,0.8, NF-PYRIDOXINE HCL TABLET 50MG,250,RC,,,,1,ME,both,0.48,0.34,,,,,,,,,,,,,,,,,,,Other,0.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.11,0.11, NF-CITRACAL + D TABLET,250,RC,,,,1,EA,both,0.68,0.48,,,,,,,,,,,,,,,,,,,Other,0.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.15,0.15, NF-VITAMIN D ORAL CAPSULE 5000IU,250,RC,,,,1,UN,both,0.55,0.39,,,,,,,,,,,,,,,,,,,Other,0.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.12,0.12, NF-DIFICID ORAL TABLET 200MG,250,RC,,,,1,ME,both,926.42,648.49,,,,,,,,,,,,,,,,,,,Other,199.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,199.73,199.73, NF-THEOPHYLLINE 12 HR TAB ER 300MG,250,RC,,,,1,ME,both,3.15,2.21,,,,,,,,,,,,,,,,,,,Other,0.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.68,0.68, NF-FOSINOPRIL SODIUM ORAL TABLET 10MG,250,RC,,,,1,ME,both,5.54,3.88,,,,,,,,,,,,,,,,,,,Other,1.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.2,1.2, NF-VALSARTAN ORAL TABLET 40MG,250,RC,,,,1,ME,both,17.95,12.57,,,,,,,,,,,,,,,,,,,Other,3.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.87,3.87, NF-LOSARTAN POTASSIUM ORAL TABLET 50MG,250,RC,,,,1,ME,both,10.71,7.5,,,,,,,,,,,,,,,,,,,Other,2.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.31,2.31, ASCLERA 1% INJ 2ML,250,RC,,,,1,ME,both,133.3,93.31,,,,,,,,,,,,,,,,,,,Other,28.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28.74,28.74, NF-PRAVASTATIN SODIUM ORAL TABLET 40MG,250,RC,,,,1,ME,both,15.36,10.75,,,,,,,,,,,,,,,,,,,Other,3.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.31,3.31, NF-MOMETASONE FUROATE NASAL SPRAY 0.05MG,250,RC,,,,1,EA,both,57.15,40.01,,,,,,,,,,,,,,,,,,,Other,12.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.32,12.32, NF-PANCREAZE CAP DR 10850U-2600U-6200U,250,RC,,,,1,UN,both,3.5,2.45,,,,,,,,,,,,,,,,,,,Other,0.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.75,0.75, NF-XIFAXAN ORAL TABLET 550MG,250,RC,,,,1,ME,both,171.73,120.21,,,,,,,,,,,,,,,,,,,Other,37.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.02,37.02, NF-RESTASIS MULTIDOSE OPHTH EMUL 0.05%,250,RC,,,,1,EA,both,432.82,302.97,,,,,,,,,,,,,,,,,,,Other,93.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,93.32,93.32, NF-IRON 100 PLUS ORAL TABLET,250,RC,,,,1,EA,both,5.36,3.75,,,,,,,,,,,,,,,,,,,Other,1.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.16,1.16, NF-VESICARE ORAL TABLET 10MG,250,RC,,,,1,ME,both,51.12,35.78,,,,,,,,,,,,,,,,,,,Other,11.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.02,11.02, NF-METHADONE HCL ORAL TABLET 10MG,250,RC,,,,1,ME,both,0.7,0.49,,,,,,,,,,,,,,,,,,,Other,0.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.15,0.15, MEGESTEROL ORAL SUSP 400MG/10ML,250,RC,,,,1,ME,both,30.23,21.16,,,,,,,,,,,,,,,,,,,Other,6.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.52,6.52, NF-XIFAXAN ORAL TABLET 550MG,250,RC,,,,1,ME,both,171.73,120.21,,,,,,,,,,,,,,,,,,,Other,37.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.02,37.02, NF-URSODIOL ORAL TABLET 500MG,250,RC,,,,1,ME,both,24.75,17.33,,,,,,,,,,,,,,,,,,,Other,5.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.34,5.34, NF-PATADAY OPHTH SOLN 0.2%,250,RC,,,,1,ML,both,353,247.1,,,,,,,,,,,,,,,,,,,Other,76.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,76.11,76.11, NF-SIMVASTATIN ORAL TABLET 20MG,250,RC,,,,1,ME,both,21.77,15.24,,,,,,,,,,,,,,,,,,,Other,4.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.69,4.69, NF-DICLOFENAC SODIUM DR TABLET 75MG,250,RC,,,,1,ME,both,8.12,5.68,,,,,,,,,,,,,,,,,,,Other,1.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.75,1.75, NF-ENTRESTO TAB 49MG-51MG,250,RC,,,,1,ME,both,37.62,26.33,,,,,,,,,,,,,,,,,,,Other,8.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.11,8.11, NF-ENTRESTO TAB 24MG-26MG,250,RC,,,,1,ME,both,37.62,26.33,,,,,,,,,,,,,,,,,,,Other,8.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.11,8.11, NF-PRAVASTATIN SODIUM ORAL TABLET 80MG,250,RC,,,,1,ME,both,22.3,15.61,,,,,,,,,,,,,,,,,,,Other,4.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.81,4.81, NF-WELLBUTRIN SR 12 HR TAB ER 100MG,250,RC,,,,1,ME,both,32.76,22.93,,,,,,,,,,,,,,,,,,,Other,7.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.07,7.07, NF-ZANTAC 300 TABLET 300MG,250,RC,,,,1,ME,both,58.14,40.7,,,,,,,,,,,,,,,,,,,Other,12.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.53,12.53, NF-HYZAAR ORAL TABLET 100MG-25MG,250,RC,,,,1,ME,both,21.48,15.04,,,,,,,,,,,,,,,,,,,Other,4.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.64,4.64, NF-HYDRALAZINE HCL ORAL TAB 50MG,250,RC,,,,1,ME,both,5.57,3.9,,,,,,,,,,,,,,,,,,,Other,1.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.21,1.21, NF-PROVERA ORAL TABLET 2.5MG,250,RC,,,,1,ME,both,6.48,4.54,,,,,,,,,,,,,,,,,,,Other,1.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.4,1.4, NF-MYRBETRIQ ORAL TABLET 50MG,250,RC,,,,1,ME,both,57.24,40.07,,,,,,,,,,,,,,,,,,,Other,12.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.34,12.34, NF-CYPROHEPTADINE HCL ORAL TABLET 4MG,250,RC,,,,1,ME,both,2.95,2.07,,,,,,,,,,,,,,,,,,,Other,0.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.64,0.64, NF-ESTERIFIED ESTROGENS-METHYLTESTOSTERO,250,RC,,,,1,ME,both,3.74,2.62,,,,,,,,,,,,,,,,,,,Other,0.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.8,0.8, NF-CO Q-10 CAPSULE 10MG,250,RC,,,,1,ME,both,1.82,1.27,,,,,,,,,,,,,,,,,,,Other,0.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.39,0.39, NF-EFUDEX CREAM 5%,250,RC,,,,1,EA,both,50.77,35.54,,,,,,,,,,,,,,,,,,,Other,10.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.95,10.95, NF-TRIAMCINOLONE OIN 0.1%,250,RC,,,,1,EA,both,0.31,0.22,,,,,,,,,,,,,,,,,,,Other,0.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.07,0.07, NF-PROBIOTIC DIGESTIVE CARE CAP 20 BILLI,250,RC,,,,1,EA,both,2.48,1.74,,,,,,,,,,,,,,,,,,,Other,0.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.54,0.54, NF-PROBIOTIC DIGESTIVE CARE ORAL TAB 10M,250,RC,,,,1,EA,both,2.83,1.98,,,,,,,,,,,,,,,,,,,Other,0.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.61,0.61, NF-OYSCO 500 + D ORAL TABLET 500MG-200IU,250,RC,,,,1,ME,both,0.06,0.04,,,,,,,,,,,,,,,,,,,Other,0.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.01,0.01, NF-VITAMIN C TABLET 100MG,250,RC,,,,1,ME,both,0.08,0.06,,,,,,,,,,,,,,,,,,,Other,0.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.02,0.02, NF-Morphine Sulfate Oral Tab ER 15MG,250,RC,,,,1,ME,both,5.81,4.07,,,,,,,,,,,,,,,,,,,Other,1.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.25,1.25, NF-NITROGLYCERIN SUBLINGUAL TABLET 0.3MG,250,RC,,,,1,ME,both,2.18,1.53,,,,,,,,,,,,,,,,,,,Other,0.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.47,0.47, NF-PREMARIN VAGINAL CREAM 0.625MG/1GM,250,RC,,,,1,ME,both,64.24,44.97,,,,,,,,,,,,,,,,,,,Other,13.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.85,13.85, NF-CHOLECALCIFEROL TAB 1000IU,250,RC,,,,1,ME,both,0.87,0.61,,,,,,,,,,,,,,,,,,,Other,0.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.19,0.19, NF-DIOVAN HCT ORAL TABLET 320MG-12.5MG,250,RC,,,,1,ME,both,58.78,41.15,,,,,,,,,,,,,,,,,,,Other,12.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.67,12.67, NF-PRAVACHOL ORAL TABLET 20MG,250,RC,,,,1,ME,both,20.36,14.25,,,,,,,,,,,,,,,,,,,Other,4.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.39,4.39, ASCORBIC ACID INJ SOLN 500MG/1ML,250,RC,,,,1,ME,both,504.79,353.35,,,,,,,,,,,,,,,,,,,Other,108.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,108.83,108.83, NF-TRULICITY SUBQ SOLN 0.75MG/0.5ML,250,RC,,,,1,ME,both,1746.06,1222.24,,,,,,,,,,,,,,,,,,,Other,376.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,376.45,376.45, NF-JARDIANCE ORAL TABLET 25MG,250,RC,,,,1,ME,both,76.2,53.34,,,,,,,,,,,,,,,,,,,Other,16.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.42,16.42, NF-TIGAN CAP 300MG,250,RC,,,,1,ME,both,20.12,14.08,,,,,,,,,,,,,,,,,,,Other,4.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.34,4.34, NF-CLOBETASOL PROPIONATE CREAM 0.05%,250,RC,,,,1,ML,both,39.73,27.81,,,,,,,,,,,,,,,,,,,Other,8.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.57,8.57, NF-LEVOTHYROXINE ORAL TABLET 200MCG,250,RC,,,,1,ME,both,2.95,2.07,,,,,,,,,,,,,,,,,,,Other,0.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.64,0.64, NF-MORPHINE SULFATE CAP ER 30MG,250,RC,,,,1,ME,both,26.4,18.48,,,,,,,,,,,,,,,,,,,Other,5.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.69,5.69, NF-INSPRA ORAL TABLET 50MG,250,RC,,,,1,ME,both,50.54,35.38,,,,,,,,,,,,,,,,,,,Other,10.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.9,10.9, NF-VICOPROFEN TABLET 2.5MG/200MG,250,RC,,,,1,ME,both,17.03,11.92,,,,,,,,,,,,,,,,,,,Other,3.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.68,3.68, NF-ONGLYZA ORAL TABLET 5MG,250,RC,,,,1,ME,both,44.21,30.95,,,,,,,,,,,,,,,,,,,Other,9.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.54,9.54, NF-ENALAPRIL/HCTZ 10MG-25MG TABLET,250,RC,,,,1,ME,both,5.67,3.97,,,,,,,,,,,,,,,,,,,Other,1.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.22,1.22, NF-LEFLUNOMIDE ORAL TABLET 20MG,250,RC,,,,1,ME,both,72.67,50.87,,,,,,,,,,,,,,,,,,,Other,15.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.67,15.67, NF-ICAPS AREDS ORAL LIQUID FILLED CAPSUL,250,RC,,,,1,ME,both,1.07,0.75,,,,,,,,,,,,,,,,,,,Other,0.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.24,0.24, NF-GLUCOSAMINE & CHONDROITIN 500MG-400MG,250,RC,,,,1,ME,both,3.73,2.61,,,,,,,,,,,,,,,,,,,Other,0.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.8,0.8, NF-IRON 100 WITH VITAMIN C ORAL TABLET,250,RC,,,,1,ME,both,0.94,0.66,,,,,,,,,,,,,,,,,,,Other,0.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.21,0.21, NF-OMEGA-3 OIL LIQUID FILLED CAPSULE 100,250,RC,,,,1,ME,both,0.4,0.28,,,,,,,,,,,,,,,,,,,Other,0.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.09,0.09, NF-CITALOPRAM HYDROBROMIDE ORAL TAB 10MG,250,RC,,,,1,ME,both,12.48,8.74,,,,,,,,,,,,,,,,,,,Other,2.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.7,2.7, NF-PRESERVISION AREDS LIQUID FILLED CAPS,250,RC,,,,1,EA,both,1.04,0.73,,,,,,,,,,,,,,,,,,,Other,0.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.23,0.23, NF-CRESTOR ORAL TABLET 10MG,250,RC,,,,1,ME,both,24.64,17.25,,,,,,,,,,,,,,,,,,,Other,5.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.31,5.31, NF-prednisoLONE ACETATE OPHTH SUSP 1%,250,RC,,,,1,ME,both,43.23,30.26,,,,,,,,,,,,,,,,,,,Other,9.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.32,9.32, NF-LIALDA ORAL DELAYED-RELEASE TABLET 1.,250,RC,,,,1,ME,both,52.22,36.55,,,,,,,,,,,,,,,,,,,Other,11.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.26,11.26, NF-CRESTOR ORAL TABLET 5MG,250,RC,,,,1,ME,both,46.17,32.32,,,,,,,,,,,,,,,,,,,Other,9.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.96,9.96, NF-LOVASTATIN ORAL TABLET 20MG,250,RC,,,,1,ME,both,12.21,8.55,,,,,,,,,,,,,,,,,,,Other,2.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.64,2.64, NF-FELODIPINE EXTENDED RELEASE TAB 10MG,250,RC,,,,1,ME,both,12.01,8.41,,,,,,,,,,,,,,,,,,,Other,2.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.59,2.59, NF-CITALOPRAM HBR ORAL TAB 40MG,250,RC,,,,1,ME,both,1.5,1.05,,,,,,,,,,,,,,,,,,,Other,0.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.32,0.32, NF-TERIPARATIDE SUBQ SOLN 250MCG/1ML,250,RC,,,,1,ME,both,6968.17,4877.72,,,,,,,,,,,,,,,,,,,Other,1502.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1502.34,1502.34, NF-TERIPARATIDE SUBQ SOLN 250MCG/1ML,250,RC,,,,1,ML,both,6968.17,4877.72,,,,,,,,,,,,,,,,,,,Other,1502.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1502.34,1502.34, EPOETIN ALPHA 2000 UNITS (PROCRIT),J0885,HCPCS,636,RC,,1,UN,both,260.4,182.28,,,,,,,,,,,,,,,,,,,Other,56.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.59,56.14, NF-DALIRESP ORAL TABLET 500MCG,250,RC,,,,1,ME,both,47.95,33.57,,,,,,,,,,,,,,,,,,,Other,10.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.34,10.34, NF-CRAN-PLUS ORAL CAPSULE,250,RC,,,,1,ME,both,0.67,0.47,,,,,,,,,,,,,,,,,,,Other,0.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.15,0.15, NF-SIMVASTATIN ORAL TABLET 20MG,250,RC,,,,1,ME,both,21.77,15.24,,,,,,,,,,,,,,,,,,,Other,4.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.69,4.69, NF-NovoLIN N (NPH) SUBQ SUSP 100U/1ML,250,RC,,,,1,ME,both,66.1,46.27,,,,,,,,,,,,,,,,,,,Other,14.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.25,14.25, NF-JUBLIA TOPICAL APPLICATION SOLUTION 1,250,RC,,,,1,ME,both,798.85,559.2,,,,,,,,,,,,,,,,,,,Other,172.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,172.24,172.24, NF-GABAPENTIN CAP 100MG,250,RC,,,,1,ME,both,3.04,2.13,,,,,,,,,,,,,,,,,,,Other,0.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.66,0.66, NF-SYMBICORT INH AER LIQ 80MCG-4.5MCG,250,RC,,,,1,ME,both,137.39,96.17,,,,,,,,,,,,,,,,,,,Other,29.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,29.63,29.63, CEFEPIME 1000 MG INJ,250,RC,,,,1,ME,both,87.44,61.21,,,,,,,,,,,,,,,,,,,Other,18.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.86,18.86, TNKASE IV POWDER FOR SOLUTION 50MG,J3101,HCPCS,636,RC,,1,ME,both,40390.42,28273.29,,,,,,,,,,,,,,,,,,,Other,8708.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,183.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,183.23,8708.17, SOTALOL 150MG/10ML INJ,250,RC,,,,1,ME,both,7332.51,5132.76,,,,,,,,,,,,,,,,,,,Other,1580.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1580.89,1580.89, NF-PAROXETINE HCL ORAL TABLET 40MG,250,RC,,,,1,ME,both,2.12,1.48,,,,,,,,,,,,,,,,,,,Other,0.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.46,0.46, PROCAINAMIDE 1000MG/10ML INJ,636,RC,,,,1,ME,both,441.08,308.76,,,,,,,,,,,,,,,,,,,Other,95.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,95.1,95.1, HYDROMORPHONE 0.5MG/0.5ML INJ (DILAUDID),J1171,HCPCS,636,RC,,1,ME,both,25.21,17.65,,,,,,,,,,,,,,,,,,,Other,5.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.14,5.44, NF-OSELTAMIVIR PHOSPHATE PWD FOR SUSP 6M,250,RC,,,,1,ME,both,11.82,8.27,,,,,,,,,,,,,,,,,,,Other,2.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.55,2.55, NF-RAMIPRIL CAP 10MG,250,RC,,,,1,ME,both,14.54,10.18,,,,,,,,,,,,,,,,,,,Other,3.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.14,3.14, NF-FEOSOL ORAL TABLET 45MG,250,RC,,,,1,ME,both,0.64,0.45,,,,,,,,,,,,,,,,,,,Other,0.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.14,0.14, NF-dexAMETHasone ELIX 0.5MG/5ML,250,RC,,,,1,ME,both,1.16,0.81,,,,,,,,,,,,,,,,,,,Other,0.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.25,0.25, NF-LACTASE TABLET,250,RC,,,,1,EA,both,0.56,0.39,,,,,,,,,,,,,,,,,,,Other,0.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.12,0.12, NF-THEO-24 24 HR CAP ER 100MG,250,RC,,,,1,ME,both,9.44,6.61,,,,,,,,,,,,,,,,,,,Other,2.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.04,2.04, NF-IBANDRONATE SODIUM ORAL TABLET 150MG,250,RC,,,,1,ME,both,599.91,419.94,,,,,,,,,,,,,,,,,,,Other,129.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,129.34,129.34, NF-TAMIFLU PWD FOR SUSP 6MG/1ML,250,RC,,,,1,ME,both,10.43,7.3,,,,,,,,,,,,,,,,,,,Other,2.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.24,2.24, NF-ZINC ACETATE CAP 25MG,250,RC,,,,1,ME,both,6.72,4.7,,,,,,,,,,,,,,,,,,,Other,1.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.45,1.45, NF-LISINOPRIL ORAL TABLET 40MG,250,RC,,,,1,ME,both,6.34,4.44,,,,,,,,,,,,,,,,,,,Other,1.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.36,1.36, NF-PULMICORT FLEXHALER INH/NEB 180MCG/1A,250,RC,,,,1,EA,both,1123.51,786.46,,,,,,,,,,,,,,,,,,,Other,242.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,242.23,242.23, NF-MEDIHONEY TOPICAL GEL 80%,250,RC,,,,1,ML,both,1.41,0.99,,,,,,,,,,,,,,,,,,,Other,0.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.3,0.3, NF-PAPAYA ENZYME TABLET,250,RC,,,,1,ME,both,14.96,10.47,,,,,,,,,,,,,,,,,,,Other,3.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.22,3.22, NF-MARINOL LIQ CAP 5MG,250,RC,,,,1,ME,both,112.24,78.57,,,,,,,,,,,,,,,,,,,Other,24.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.2,24.2, NF-GLYNASE PRES-TAB ORAL TABLET 3MG,250,RC,,,,1,ME,both,11.39,7.97,,,,,,,,,,,,,,,,,,,Other,2.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.46,2.46, NF-SAM-E 400 ORAL TABLET EC 400MG,250,RC,,,,1,ME,both,5.6,3.92,,,,,,,,,,,,,,,,,,,Other,1.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.21,1.21, NF-NYSTATIN/TRIAMCINOLONE ACETONID OINTM,250,RC,,,,1,EA,both,22.99,16.09,,,,,,,,,,,,,,,,,,,Other,4.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.96,4.96, NF-FENOFIBRATE AVPAK ORAL TABLET 48MG,250,RC,,,,1,ME,both,7.84,5.49,,,,,,,,,,,,,,,,,,,Other,1.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.69,1.69, POTASSIUM PHOSPHATE ORIGINAL TAB 500MG,250,RC,,,,1,ME,both,6.75,4.73,,,,,,,,,,,,,,,,,,,Other,1.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.46,1.46, NF-MODAFINIL AVPAK ORAL TABLET 200MG,250,RC,,,,1,ME,both,145.5,101.85,,,,,,,,,,,,,,,,,,,Other,31.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,31.37,31.37, NF-FOSINOPRIL SODIUM ORAL TABLET 40MG,250,RC,,,,1,ME,both,5.14,3.6,,,,,,,,,,,,,,,,,,,Other,1.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.11,1.11, NF-NEXIUM 24HR CAP DR 20MG,250,RC,,,,1,ME,both,2.77,1.94,,,,,,,,,,,,,,,,,,,Other,0.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.6,0.6, NF-BISOPROLOL FUMARATE TAB 5MG,250,RC,,,,1,ME,both,16.07,11.25,,,,,,,,,,,,,,,,,,,Other,3.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.47,3.47, NF-EXEMESTANE ORAL TABLET 25MG,250,RC,,,,1,ME,both,83.28,58.3,,,,,,,,,,,,,,,,,,,Other,17.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.95,17.95, NF-EXEMESTANE ORAL TABLET 25MG,250,RC,,,,1,ME,both,83.28,58.3,,,,,,,,,,,,,,,,,,,Other,17.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.95,17.95, NF-COENZYME Q10 LIQ CAP 100MG,250,RC,,,,1,ME,both,2.09,1.46,,,,,,,,,,,,,,,,,,,Other,0.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.45,0.45, NF-SAXAGLIPTIN HYDROCHLORIDE TAB 5MG,250,RC,,,,1,ME,both,51.13,35.79,,,,,,,,,,,,,,,,,,,Other,11.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.02,11.02, NF-PERFOROMIST INH SOLN 20MCG/2ML,250,RC,,,,1,ME,both,42.04,29.43,,,,,,,,,,,,,,,,,,,Other,9.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.06,9.06, NF-PROTONIX TAB EC 40MG,250,RC,,,,1,ME,both,25.83,18.08,,,,,,,,,,,,,,,,,,,Other,5.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.57,5.57, NF-QUINAPRIL HCL TAB 40MG,250,RC,,,,1,ME,both,16.33,11.43,,,,,,,,,,,,,,,,,,,Other,3.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.52,3.52, NF-LOTENSIN HCT ORAL TABLET 10MG-12.5MG,250,RC,,,,1,ME,both,11.54,8.08,,,,,,,,,,,,,,,,,,,Other,2.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.49,2.49, NF-TRIAMCINOLONE ACETONIDE CREAM 0.025%,250,RC,,,,1,EA,both,0.43,0.3,,,,,,,,,,,,,,,,,,,Other,0.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.09,0.09, NF-TIMOLOL MALEATE OPHTH GEL DROP 0.25%,250,RC,,,,1,EA,both,171.45,120.02,,,,,,,,,,,,,,,,,,,Other,36.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.97,36.97, NF-TRADJENTA TAB 5MG,250,RC,,,,1,ME,both,67.75,47.43,,,,,,,,,,,,,,,,,,,Other,14.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.61,14.61, NF-TIMOLOL MALEATE OPHTH GEL DROP 0.5%,250,RC,,,,1,ML,both,50.6,35.42,,,,,,,,,,,,,,,,,,,Other,10.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.91,10.91, NF-MICROLIPID OIL,250,RC,,,,1,EA,both,0.08,0.06,,,,,,,,,,,,,,,,,,,Other,0.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.02,0.02, NF-LEUPROLIDE ACETATE IM 3 MONTH PWD FOR,250,RC,,,,1,EA,both,22715.33,15900.73,,,,,,,,,,,,,,,,,,,Other,4897.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4897.42,4897.42, NF-COMBIGAN OPHTH SOLN 0.2%-0.5%,250,RC,,,,1,ML,both,167.12,116.98,,,,,,,,,,,,,,,,,,,Other,36.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.03,36.03, NF-CO Q-10 CAPSULE 50MG,250,RC,,,,1,ME,both,1.53,1.07,,,,,,,,,,,,,,,,,,,Other,0.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.33,0.33, NF-HYDROCORTISONE ACETATE CRM 2.5%,250,RC,,,,1,EA,both,42,29.4,,,,,,,,,,,,,,,,,,,Other,9.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.06,9.06, NF-DULERA INH AER PWD 5MCG-100MCG/ACT,250,RC,,,,1,ME,both,124.28,87,,,,,,,,,,,,,,,,,,,Other,26.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.79,26.79, NF-JARDIANCE ORAL TABLET 25MG,637,RC,,,,1,ME,both,76.55,53.59,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-CYTOMEL TABLET 25MCG,250,RC,,,,1,ME,both,5.11,3.58,,,,,,,,,,,,,,,,,,,Other,1.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.1,1.1, NF-VELTASSA POWDERFORSUSPENSION 8.4GM/1P,250,RC,,,,1,ME,both,216.6,151.62,,,,,,,,,,,,,,,,,,,Other,46.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,46.7,46.7, NF-SELENIUM TABLET 100MCG,250,RC,,,,1,ME,both,0.06,0.04,,,,,,,,,,,,,,,,,,,Other,0.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.01,0.01, NF-PROCTOCORT RECTAL CREAM 1%,250,RC,,,,1,EA,both,7.46,5.22,,,,,,,,,,,,,,,,,,,Other,1.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.61,1.61, NF-GAS-X ULTRA STRENGTH LIQ CAP 180MG,250,RC,,,,1,ME,both,1.23,0.86,,,,,,,,,,,,,,,,,,,Other,0.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.26,0.26, EMPAGLIFLOZIN 10MG TAB (JARDIANCE),250,RC,,,,1,ME,both,108.26,75.78,,,,,,,,,,,,,,,,,,,Other,23.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.34,23.34, NF-TRAVATAN Z OPHTH SOLN 0.004%,250,RC,,,,1,ML,both,353.39,247.37,,,,,,,,,,,,,,,,,,,Other,76.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,76.2,76.2, NF-CREON ORAL DELAYED RELEASE CAPSULE,250,RC,,,,1,ME,both,15.2,10.64,,,,,,,,,,,,,,,,,,,Other,3.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.27,3.27, NF-VALSARTAN AND HYDROCHLOROTHIAZIDE TAB,250,RC,,,,1,EA,both,18.5,12.95,,,,,,,,,,,,,,,,,,,Other,3.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.99,3.99, NF-DAPTOMYCIN IV PWD FOR SOLN 350MG,250,RC,,,,1,ME,both,1368.16,957.71,,,,,,,,,,,,,,,,,,,Other,294.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,294.98,294.98, NF-ENTOCORT EC CAP DR 3MG,250,RC,,,,1,ME,both,71.2,49.84,,,,,,,,,,,,,,,,,,,Other,15.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.35,15.35, NF-JANUMET ORAL TABLET 50MG-1000MG,250,RC,,,,1,ME,both,19.47,13.63,,,,,,,,,,,,,,,,,,,Other,4.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.19,4.19, NF-VITA-BEE WITH C ORAL TABLET,250,RC,,,,1,ME,both,0.19,0.13,,,,,,,,,,,,,,,,,,,Other,0.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.04,0.04, NF-PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.125,250,RC,,,,1,ME,both,8.96,6.27,,,,,,,,,,,,,,,,,,,Other,1.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.93,1.93, NF-HYDROXYZINE PAMOATE CAP 50MG,250,RC,,,,1,ME,both,2.47,1.73,,,,,,,,,,,,,,,,,,,Other,0.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.53,0.53, NF-RAMIPRIL CAP 10MG,250,RC,,,,1,ME,both,15.45,10.82,,,,,,,,,,,,,,,,,,,Other,3.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.33,3.33, NF-SEREVENT DISKUS INH PWD 50MCG/1ACTUAT,250,RC,,,,1,EA,both,32.54,22.78,,,,,,,,,,,,,,,,,,,Other,7.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.02,7.02, NF-TELMISARTAN ORAL TABLET 80MG,250,RC,,,,1,ME,both,19.85,13.9,,,,,,,,,,,,,,,,,,,Other,4.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.28,4.28, NF-TRELEGY ELLIPTA 100/62.5/25MCG INH,250,RC,,,,1,EA,both,45.84,32.09,,,,,,,,,,,,,,,,,,,Other,9.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.88,9.88, NF-TOBI INH/NEB SOLN 300MG/5ML,250,RC,,,,1,ME,both,553.72,387.6,,,,,,,,,,,,,,,,,,,Other,119.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,119.38,119.38, NF-COLESTIPOL HCL TAB 1GM,250,RC,,,,1,GM,both,5.35,3.75,,,,,,,,,,,,,,,,,,,Other,1.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.16,1.16, NF-PROVIGIL ORAL TABLET 200MG,250,RC,,,,1,ME,both,213.07,149.15,,,,,,,,,,,,,,,,,,,Other,45.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,45.94,45.94, NF-MODAFINIL ORAL TABLET 100MG,250,RC,,,,1,ME,both,90.63,63.44,,,,,,,,,,,,,,,,,,,Other,19.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.54,19.54, NF-MODAFINIL ORAL TABLET 200MG,250,RC,,,,1,ME,both,137.21,96.05,,,,,,,,,,,,,,,,,,,Other,29.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,29.59,29.59, NF-VITAMIN A CAPSULE 8000IU,250,RC,,,,1,UN,both,0.11,0.08,,,,,,,,,,,,,,,,,,,Other,0.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.02,0.02, NF-FARXIGA ORAL TABLET 5MG,250,RC,,,,1,ME,both,51.38,35.97,,,,,,,,,,,,,,,,,,,Other,11.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.07,11.07, NF-TIMOLOL MALEATE OPHTH SOLN 0.5%,250,RC,,,,1,ML,both,5.19,3.63,,,,,,,,,,,,,,,,,,,Other,1.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.12,1.12, NF-SYNJARDY XR ORAL TAB ER 12.5MG-1000MG,250,RC,,,,1,ME,both,40.21,28.15,,,,,,,,,,,,,,,,,,,Other,8.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.67,8.67, KAYEXALATE PWDR,637,RC,,,,1,EA,both,756.77,529.74,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-MILK THISTLE CAPSULE 150MG,250,RC,,,,1,ME,both,0.91,0.64,,,,,,,,,,,,,,,,,,,Other,0.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.2,0.2, NF-TRIHEXYPHENIDYL HCL TAB 2MG,250,RC,,,,1,ME,both,0.79,0.55,,,,,,,,,,,,,,,,,,,Other,0.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.17,0.17, NF-QVAR REDIHALER INH AEROSOL LIQ 0.04MG,250,RC,,,,1,ME,both,82.88,58.02,,,,,,,,,,,,,,,,,,,Other,17.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.87,17.87, NF-METFORMIN HCL ORAL TABLET 850MG,250,RC,,,,1,ME,both,5.19,3.63,,,,,,,,,,,,,,,,,,,Other,1.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.12,1.12, NF-MIRTAZAPINE DISINTEGRATING TAB 15MG,250,RC,,,,1,ME,both,10.02,7.01,,,,,,,,,,,,,,,,,,,Other,2.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.16,2.16, NF-TRANEXAMIC ACID ORAL TABLET 650MG,250,RC,,,,1,ME,both,22.55,15.79,,,,,,,,,,,,,,,,,,,Other,4.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.86,4.86, NF-raNITIdine HCL ORAL SYRUP 15MG/1ML,250,RC,,,,1,ME,both,3.2,2.24,,,,,,,,,,,,,,,,,,,Other,0.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.69,0.69, NF-ESTRADIOL TRANSDERMAL SYS 0.1MG/24HR,250,RC,,,,1,ME,both,49.09,34.36,,,,,,,,,,,,,,,,,,,Other,10.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.58,10.58, NF-SELEGILINE HCL CAP 5MG,250,RC,,,,1,ME,both,11.68,8.18,,,,,,,,,,,,,,,,,,,Other,2.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.52,2.52, NF-NORGESTIMATE AND ETHINYL ESTRADIOL,250,RC,,,,1,EA,both,6.07,4.25,,,,,,,,,,,,,,,,,,,Other,1.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.31,1.31, NF-VITAMIN B COMPLEX TAB,250,RC,,,,1,EA,both,2.28,1.6,,,,,,,,,,,,,,,,,,,Other,0.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.49,0.49, SODIUM CHLORIDE 7% (RESP) 4ML,250,RC,,,,1,ML,both,16.48,11.54,,,,,,,,,,,,,,,,,,,Other,3.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.56,3.56, NF-MACULAR HEALTH FORMULA ORAL CAPSULE,250,RC,,,,1,EA,both,3.06,2.14,,,,,,,,,,,,,,,,,,,Other,0.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.66,0.66, NF-DORZOLAMIDE HCL OPHTH SOLN 2%,250,RC,,,,1,ML,both,29.14,20.4,,,,,,,,,,,,,,,,,,,Other,6.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.28,6.28, NF-LUMIGAN OPHTH SOLN 0.01%,250,RC,,,,1,ML,both,373.23,261.26,,,,,,,,,,,,,,,,,,,Other,80.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,80.47,80.47, "NF-OCTREOTIDE ACETATE INJ SOLN 1,000MCG/",250,RC,,,,1,ME,both,681.08,476.76,,,,,,,,,,,,,,,,,,,Other,146.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,146.84,146.84, NF-MORPHINE SULFATE IR ORAL TABLET 15MG,250,RC,,,,1,ME,both,1.71,1.2,,,,,,,,,,,,,,,,,,,Other,0.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.37,0.37, NF-PEDVAXHIB IM SOLN 7.5MCG/0.5ML,250,RC,,,,1,ME,both,270.97,189.68,,,,,,,,,,,,,,,,,,,Other,58.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,58.42,58.42, NF-LINZESS CAP 145MCG,250,RC,,,,1,ME,both,66.96,46.87,,,,,,,,,,,,,,,,,,,Other,14.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.44,14.44, NF-MYRBETRIQ ORAL TABLET 50MG,250,RC,,,,1,ME,both,58.05,40.64,,,,,,,,,,,,,,,,,,,Other,12.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.51,12.51, NF-OXYCODONE HCL ORAL TAB 15MG,250,RC,,,,1,ME,both,8.19,5.73,,,,,,,,,,,,,,,,,,,Other,1.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.76,1.76, NF-TRANEXAMIC ACID ORAL TABLET 650MG,250,RC,,,,1,ME,both,32.04,22.43,,,,,,,,,,,,,,,,,,,Other,6.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.91,6.91, NF-TAGRISSO TAB 80MG,250,RC,,,,1,ME,both,2406.45,1684.52,,,,,,,,,,,,,,,,,,,Other,518.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,518.83,518.83, NF-DIGESTIVE ENZYMES TABLET,250,RC,,,,1,ME,both,0.39,0.27,,,,,,,,,,,,,,,,,,,Other,0.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.09,0.09, NF-GABAPENTIN AVPAK ORAL TABLET 800MG,250,RC,,,,1,ME,both,11.96,8.37,,,,,,,,,,,,,,,,,,,Other,2.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.58,2.58, NF-ZANTAC 150 TAB 150MG,250,RC,,,,1,ME,both,17.89,12.52,,,,,,,,,,,,,,,,,,,Other,3.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.86,3.86, NF-XYZAL ALLERGY 24HR ORAL TABLET 5MG,250,RC,,,,1,ME,both,6.75,4.73,,,,,,,,,,,,,,,,,,,Other,1.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.46,1.46, NF-MORPHINE SULFATE 24 HR CAP ER 45MG,250,RC,,,,1,ME,both,36.74,25.72,,,,,,,,,,,,,,,,,,,Other,7.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.92,7.92, NF-MUCINEX DM TAB ER,250,RC,,,,1,ME,both,2.4,1.68,,,,,,,,,,,,,,,,,,,Other,0.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.52,0.52, NF-LEXAPRO ORAL TABLET 10MG,250,RC,,,,1,ME,both,17.2,12.04,,,,,,,,,,,,,,,,,,,Other,3.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.7,3.7, NF-XTANDI LIQ CAP 40MG,250,RC,,,,1,ME,both,448.86,314.2,,,,,,,,,,,,,,,,,,,Other,96.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,96.78,96.78, NF-RIVASTIGMINE TD PATCH ER 9.5MG/24HR,250,RC,,,,1,ME,both,43.73,30.61,,,,,,,,,,,,,,,,,,,Other,9.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.43,9.43, NF-REFRESH OPHTH SOLUTION,250,RC,,,,1,EA,both,1.49,1.04,,,,,,,,,,,,,,,,,,,Other,0.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.32,0.32, NF-PAPAYA ENZYME TABLET,250,RC,,,,1,EA,both,14.96,10.47,,,,,,,,,,,,,,,,,,,Other,3.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.22,3.22, NF-FOLBEE-PLUS CZ TAB,250,RC,,,,1,EA,both,3.06,2.14,,,,,,,,,,,,,,,,,,,Other,0.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.66,0.66, NF-PRILOSEC CAP DR 20MG,250,RC,,,,1,ME,both,27.48,19.24,,,,,,,,,,,,,,,,,,,Other,5.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.93,5.93, NF-PROGESTERONE IM OIL 50MG/1ML,250,RC,,,,1,ME,both,16.25,11.38,,,,,,,,,,,,,,,,,,,Other,3.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.51,3.51, NF-VIVELLE-DOT TD PATCH ER 0.0375MG/24HR,250,RC,,,,1,ME,both,78.65,55.06,,,,,,,,,,,,,,,,,,,Other,16.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.95,16.95, NF-PROGESTERONE LIQ CAP 100MG,250,RC,,,,1,ME,both,11.29,7.9,,,,,,,,,,,,,,,,,,,Other,2.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.43,2.43, NF-DAPTOMYCIN IV PWD FOR SOLN 500MG,250,RC,,,,1,ME,both,2200.37,1540.26,,,,,,,,,,,,,,,,,,,Other,474.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,474.4,474.4, NF-DAPTOMYCIN IV PWD FOR SOLN 500MG,250,RC,,,,1,ME,both,2200.33,1540.23,,,,,,,,,,,,,,,,,,,Other,474.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,474.39,474.39, NF-MICONAZOLE POWDER,250,RC,,,,1,ME,both,181.62,127.13,,,,,,,,,,,,,,,,,,,Other,39.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,39.16,39.16, NF-ENTRESTO ORAL TABLET 49MG-51MG,250,RC,,,,1,ME,both,40.07,28.05,,,,,,,,,,,,,,,,,,,Other,8.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.64,8.64, NF-WELLBUTRIN XL TABLET ER 300MG,250,RC,,,,1,EA,both,37.86,26.5,,,,,,,,,,,,,,,,,,,Other,8.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.16,8.16, NF-GABAPENTIN SUSP 25MG/1ML,250,RC,,,,1,ME,both,5.62,3.93,,,,,,,,,,,,,,,,,,,Other,1.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.22,1.22, NF-GABAPENTIN ORAL SOLUTION 250MG/5ML,250,RC,,,,1,ME,both,1.37,0.96,,,,,,,,,,,,,,,,,,,Other,0.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.29,0.29, NF-GABAPENTIN AVPAK ORAL TABLET 600MG,250,RC,,,,1,ME,both,9.81,6.87,,,,,,,,,,,,,,,,,,,Other,2.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.12,2.12, NF-JANUVIA ORAL TABLET 100MG,250,RC,,,,1,ME,both,70.73,49.51,,,,,,,,,,,,,,,,,,,Other,15.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.25,15.25, NF-OXCARBAZEPINE ORAL TABLET 300MG,250,RC,,,,1,ME,both,10.87,7.61,,,,,,,,,,,,,,,,,,,Other,2.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.34,2.34, NF-PIOGLITAZONE HCL ORAL TABLET 45MG,250,RC,,,,1,ME,both,50.23,35.16,,,,,,,,,,,,,,,,,,,Other,10.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.83,10.83, NF-LISINOPRIL ORAL TABLET 10MG,250,RC,,,,1,ME,both,4.09,2.86,,,,,,,,,,,,,,,,,,,Other,0.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.88,0.88, NF-LISINOPRIL ORAL TABLET 10MG,250,RC,,,,1,ME,both,0.93,0.65,,,,,,,,,,,,,,,,,,,Other,0.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.2,0.2, NF-GUAIFENESIN ORAL TABLET 400MG,250,RC,,,,1,ME,both,12.28,8.6,,,,,,,,,,,,,,,,,,,Other,2.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.65,2.65, NF-OXYBUTYNIN CHLORIDE ORAL TAB ER 10MG,250,RC,,,,1,ME,both,14.22,9.95,,,,,,,,,,,,,,,,,,,Other,3.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.07,3.07, NF-CONCERTA TAB ER 36MG,250,RC,,,,1,ME,both,29.39,20.57,,,,,,,,,,,,,,,,,,,Other,6.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.34,6.34, NF-OPDIVO INTRAVENOUS SOLUTION 10MG/1ML,250,RC,,,,1,ME,both,1401.8,981.26,,,,,,,,,,,,,,,,,,,Other,302.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,302.23,302.23, NF-KETOCONAZOLE CREAM 2%,250,RC,,,,1,EA,both,9.8,6.86,,,,,,,,,,,,,,,,,,,Other,2.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.12,2.12, NF-HOMEOPATHIC CHEW TAB,250,RC,,,,1,EA,both,1.18,0.83,,,,,,,,,,,,,,,,,,,Other,0.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.25,0.25, NF-PROLENSA OPHTH SOLN 0.07%,250,RC,,,,1,EA,both,461.27,322.89,,,,,,,,,,,,,,,,,,,Other,99.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,99.45,99.45, NF-MURO-128 OPHTH OINTMENT 5%,250,RC,,,,1,EA,both,107.5,75.25,,,,,,,,,,,,,,,,,,,Other,23.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.18,23.18, BALOXAVIR 40 MG TAB,250,RC,,,,1,ME,both,398.22,278.75,,,,,,,,,,,,,,,,,,,Other,85.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,85.86,85.86, NF-ANORO ELLIPTA INH PWD 62.5MCG-25MCG/1,250,RC,,,,1,EA,both,35.43,24.8,,,,,,,,,,,,,,,,,,,Other,7.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.63,7.63, KCENTRA 500 UNIT RANGE,J7168,HCPCS,636,RC,,1,UN,both,8466.7,5926.69,,,,,,,,,,,,,,,,,,,Other,1825.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1825.42,1825.42, NF-CHLORTHALIDONE ORAL TABLET 25MG,250,RC,,,,1,ME,both,9.46,6.62,,,,,,,,,,,,,,,,,,,Other,2.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.04,2.04, NF-TERAZOSIN HCL CAP 10MG,250,RC,,,,1,ME,both,6.94,4.86,,,,,,,,,,,,,,,,,,,Other,1.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.5,1.5, NF-SPRINTEC TABLET,250,RC,,,,1,EA,both,10.22,7.15,,,,,,,,,,,,,,,,,,,Other,2.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.2,2.2, NF-NAMENDA TAB 10MG,250,RC,,,,1,ME,both,36.61,25.63,,,,,,,,,,,,,,,,,,,Other,7.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.89,7.89, NF-ACTOS ORAL TABLET 45MG,250,RC,,,,1,ME,both,106.04,74.23,,,,,,,,,,,,,,,,,,,Other,22.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.86,22.86, NF-DULOXETINE CAPSULE DELAYED RELEASE 60,250,RC,,,,1,EA,both,30.19,21.13,,,,,,,,,,,,,,,,,,,Other,6.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.51,6.51, NF-HYDROCHLOROTHIAZIDE CAP 12.5MG,250,RC,,,,1,ME,both,1.83,1.28,,,,,,,,,,,,,,,,,,,Other,0.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.39,0.39, NF-PRAMIPEXOLE DIHYDROCHLORIDE TAB 1MG,250,RC,,,,1,ME,both,34.68,24.28,,,,,,,,,,,,,,,,,,,Other,7.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.48,7.48, NF-FEXOFENADINE HCL ORAL TAB 180MG,250,RC,,,,1,ME,both,2.78,1.95,,,,,,,,,,,,,,,,,,,Other,0.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.6,0.6, NF-PULMICORT FLEX INH/NEB PWD 180MCG/1AC,250,RC,,,,1,ME,both,812.43,568.7,,,,,,,,,,,,,,,,,,,Other,175.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,175.16,175.16, NF-ESOMEPRAZOLE MAGNESIUM CAP DR 40MG,250,RC,,,,1,ME,both,43.4,30.38,,,,,,,,,,,,,,,,,,,Other,9.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.36,9.36, NF-LETROZOLE ORAL TABLET 2.5MG,250,RC,,,,1,ME,both,78.34,54.84,,,,,,,,,,,,,,,,,,,Other,16.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.89,16.89, NF-PRANDIN TAB 2MG,250,RC,,,,1,ME,both,5.95,4.17,,,,,,,,,,,,,,,,,,,Other,1.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.28,1.28, NF-PRESERVISION AREDS ORAL LIQUID CAPSUL,250,RC,,,,1,ME,both,1.15,0.81,,,,,,,,,,,,,,,,,,,Other,0.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.24,0.24, NF-TURMERIC ORAL TABLET 1053MG,250,RC,,,,1,ME,both,1.48,1.04,,,,,,,,,,,,,,,,,,,Other,0.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.32,0.32, "NF-COQ10 ORAL CAPSULE, LIQUID FILLED 200",250,RC,,,,1,EA,both,1.83,1.28,,,,,,,,,,,,,,,,,,,Other,0.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.39,0.39, NF-LEVOCARNITINE CAP 330MG,250,RC,,,,1,ME,both,1.13,0.79,,,,,,,,,,,,,,,,,,,Other,0.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.24,0.24, NF-TOUJEO SUBCUTANEOUS SOLUTION 300U/1ML,250,RC,,,,1,UN,both,414.63,290.24,,,,,,,,,,,,,,,,,,,Other,89.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,89.4,89.4, NF-CYMBALTA CAP DR 20MG,250,RC,,,,1,ME,both,22.21,15.55,,,,,,,,,,,,,,,,,,,Other,4.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.79,4.79, NF-ESTRADIOL TRANSDERMAL SYS 0.05MG/24HR,250,RC,,,,1,ME,both,45.34,31.74,,,,,,,,,,,,,,,,,,,Other,9.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.77,9.77, NF-TRIAZOLAM ORAL TABLET 0.25MG,250,RC,,,,1,ME,both,3.78,2.65,,,,,,,,,,,,,,,,,,,Other,0.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.81,0.81, NF-CITALOPRAM HYDROBROMIDE ORAL TABLET 1,250,RC,,,,1,EA,both,9.83,6.88,,,,,,,,,,,,,,,,,,,Other,2.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.12,2.12, NF-INCRUSE ELLIPTA INH PWD 62.5MCG/1ACT,250,RC,,,,1,EA,both,48.51,33.96,,,,,,,,,,,,,,,,,,,Other,10.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.46,10.46, "NF-PALIPERIDONE ORAL TABLET, ER 6MG",250,RC,,,,1,ME,both,122.11,85.48,,,,,,,,,,,,,,,,,,,Other,26.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.32,26.32, NF-OMEGA-3 KRILL OIL CAPSULE LIQUID FILL,250,RC,,,,1,ME,both,1.15,0.81,,,,,,,,,,,,,,,,,,,Other,0.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.24,0.24, NF-MYRBETRIQ ORAL TABLET 25MG,250,RC,,,,1,ME,both,61.49,43.04,,,,,,,,,,,,,,,,,,,Other,13.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.26,13.26, OSELTAMIVIR 30MG CAP (TAMIFLU),637,RC,,,,1,ME,both,60.97,42.68,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-TRESIBA SUBQ SOLN 100U/1ML,250,RC,,,,1,UN,both,162.7,113.89,,,,,,,,,,,,,,,,,,,Other,35.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.07,35.07, NF-BYSTOLIC ORAL TABLET 10MG,250,RC,,,,1,ME,both,22.92,16.04,,,,,,,,,,,,,,,,,,,Other,4.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.94,4.94, "NF-CREON 24,000 UNITS CAP",250,RC,,,,1,UN,both,31.78,22.25,,,,,,,,,,,,,,,,,,,Other,6.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.85,6.85, NF-HALCION ORAL TABLET 0.25MG,250,RC,,,,1,ME,both,26.84,18.79,,,,,,,,,,,,,,,,,,,Other,5.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.78,5.78, NF-BUPROPION HCL ORAL TABLET 75MG,250,RC,,,,1,ME,both,3.18,2.23,,,,,,,,,,,,,,,,,,,Other,0.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.69,0.69, NF-SYMBICORT INH AER LIQ 80MCG-4.5MCG,250,RC,,,,1,EA,both,146.79,102.75,,,,,,,,,,,,,,,,,,,Other,31.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,31.64,31.64, NF-COMBIVENT INH AER PWD 103MCG-18MCG/1,250,RC,,,,1,EA,both,91.82,64.27,,,,,,,,,,,,,,,,,,,Other,19.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.8,19.8, NF-SYMBICORT INH AER LIQ 160MCG-4.5MCG/1,250,RC,,,,1,EA,both,168.11,117.68,,,,,,,,,,,,,,,,,,,Other,36.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.24,36.24, NF-SYMBICORT INH AER LIQ 160MCG-4.5MCG/1,250,RC,,,,1,EA,both,153.98,107.79,,,,,,,,,,,,,,,,,,,Other,33.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,33.2,33.2, NF-SYMBICORT INH AER LIQ 160MCG-4.5MCG/1,250,RC,,,,1,EA,both,106.39,74.47,,,,,,,,,,,,,,,,,,,Other,22.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.94,22.94, NF-COMBIVENT INH AER PWD 103MCG-18MCG/1,250,RC,,,,1,EA,both,91.82,64.27,,,,,,,,,,,,,,,,,,,Other,19.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.8,19.8, NF-COMBIVENT INH AER PWD 103MCG-18MCG/1,250,RC,,,,1,EA,both,91.82,64.27,,,,,,,,,,,,,,,,,,,Other,19.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.8,19.8, ALBUTEROL HFA INH SUSP 0.09MG/1ACT,250,RC,,,,1,EA,both,12.5,8.75,,,,,,,,,,,,,,,,,,,Other,2.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.7,2.7, IPRATROP/ALB RESP INH 100MCG-20MCG/ACT,250,RC,,,,1,EA,both,21.04,14.73,,,,,,,,,,,,,,,,,,,Other,4.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.54,4.54, NF-HYZAAR ORAL TABLET 50MG-12.5MG,250,RC,,,,1,ME,both,8.19,5.73,,,,,,,,,,,,,,,,,,,Other,1.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.76,1.76, NF-DONEPEZIL HCL ORAL TABLET 10MG,250,RC,,,,1,ME,both,31.15,21.81,,,,,,,,,,,,,,,,,,,Other,6.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.71,6.71, INDOCYANINE GREEN INJ 25MG,250,RC,,,,1,ME,both,1536.35,1075.45,,,,,,,,,,,,,,,,,,,Other,331.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,331.24,331.24, NF-VIRT-GARD TAB 1MG-2.2MG-25MG,250,RC,,,,1,ME,both,2,1.4,,,,,,,,,,,,,,,,,,,Other,0.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.43,0.43, HALOPERIDOL DECAN 50MG/ML INJ,250,RC,,,,1,ME,both,122.55,85.79,,,,,,,,,,,,,,,,,,,Other,26.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.42,26.42, RAPID INTUBATION KIT,250,RC,,,,1,EA,both,154.8,108.36,,,,,,,,,,,,,,,,,,,Other,33.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,33.38,33.38, NF-PROTEGRA ANTIOXIDANT CAPSULE,250,RC,,,,1,ME,both,0.42,0.29,,,,,,,,,,,,,,,,,,,Other,0.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.09,0.09, NF-GERITOL COMPLETE ORAL TABLET,250,RC,,,,1,ME,both,0.36,0.25,,,,,,,,,,,,,,,,,,,Other,0.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.08,0.08, NF-ENTRESTO ORAL TABLET 24MG-26MG,250,RC,,,,1,ME,both,43.58,30.51,,,,,,,,,,,,,,,,,,,Other,9.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.4,9.4, NF-EFFEXOR XR EXTENDED RELEASE CAPSULE 7,250,RC,,,,1,ME,both,29.84,20.89,,,,,,,,,,,,,,,,,,,Other,6.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.43,6.43, NF-FELODIPINE EXTENDED RELEASE TABLET 10,250,RC,,,,1,ME,both,10.86,7.6,,,,,,,,,,,,,,,,,,,Other,2.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.34,2.34, NF-SUMATRIPTAN SUCCINATE ORAL TABLET 25M,250,RC,,,,1,ME,both,108.21,75.75,,,,,,,,,,,,,,,,,,,Other,23.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.33,23.33, NF-FELODIPINE EXTENDED RELEASE TABLET 5M,250,RC,,,,1,ME,both,6.04,4.23,,,,,,,,,,,,,,,,,,,Other,1.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.3,1.3, PAMIDRONATE INJ 30MG/10ML,J2430,HCPCS,636,RC,,1,ME,both,139.32,97.52,,,,,,,,,,,,,,,,,,,Other,30.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.06,30.04, NF-VENLAFAXINE HCL ORAL TABLET 100MG,250,RC,,,,1,ME,both,11.84,8.29,,,,,,,,,,,,,,,,,,,Other,2.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.55,2.55, NF-LEVOCETIRIZINE DIHCL ORAL TABLET 5MG,250,RC,,,,1,ME,both,12.31,8.62,,,,,,,,,,,,,,,,,,,Other,2.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.66,2.66, NF-ENALAPRIL MALEATE ORAL TABLET 2.5MG,250,RC,,,,1,ME,both,5.83,4.08,,,,,,,,,,,,,,,,,,,Other,1.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.25,1.25, NF-LOSARTAN AND HYDROCHLOROTHIAZIDE 100-,250,RC,,,,1,ME,both,13.63,9.54,,,,,,,,,,,,,,,,,,,Other,2.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.94,2.94, NF-1ST BASE CREAM,121,RC,,,,1,EA,both,55.16,38.61,,,,,,,,,,,,,,,,,,,Per Diem,2826.98,,Reimbursement is subject to Medicare Sequestration.,,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,,,,,,,,,,2826.98,2826.98, GABAPENTIN SOLN 250MG/5ML,250,RC,,,,1,ME,both,34,23.8,,,,,,,,,,,,,,,,,,,Other,7.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.33,7.33, ROCURONIUM 50MG/5ML INJ,250,RC,,,,1,ME,both,45.15,31.61,,,,,,,,,,,,,,,,,,,Other,9.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.73,9.73, NF-B COMPLEX TABLET,250,RC,,,,1,ME,both,0.09,0.06,,,,,,,,,,,,,,,,,,,Other,0.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.02,0.02, NF-PRESERVISION LUTEIN ORAL LIQUID CAPSU,250,RC,,,,1,EA,both,0.76,0.53,,,,,,,,,,,,,,,,,,,Other,0.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.17,0.17, NF-XOPENEX HFA INH/NEB AER PWD 0.045MG/1,250,RC,,,,1,EA,both,21.84,15.29,,,,,,,,,,,,,,,,,,,Other,4.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.7,4.7, NF-HALDOL DECANOATE IM OIL 50MG/1ML,250,RC,,,,1,ML,both,417.95,292.57,,,,,,,,,,,,,,,,,,,Other,90.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,90.11,90.11, CREON 6000 UNITS CAP,250,RC,,,,1,UN,both,10.72,7.5,,,,,,,,,,,,,,,,,,,Other,2.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.31,2.31, SEPTRA 800MG/160MG 10 CC IV,J3490,HCPCS,636,RC,,1,ME,both,35.86,25.1,,,,,,,,,,,,,,,,,,,Other,7.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.73,7.73, NF-PREDNISONE ORAL TABLET 2.5MG,250,RC,,,,1,ME,both,0.66,0.46,,,,,,,,,,,,,,,,,,,Other,0.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.15,0.15, NF-DILAUDID ORAL SOLUTION 1MG/1ML,250,RC,,,,1,ME,both,4.84,3.39,,,,,,,,,,,,,,,,,,,Other,1.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.04,1.04, NF-FOLIC ACID ORAL TABLET 0.4MG,250,RC,,,,1,ME,both,0.04,0.03,,,,,,,,,,,,,,,,,,,Other,0.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.01,0.01, NF-OMEGA 3-6-9 ORAL LIQUID FILLED CAPSUL,121,RC,,,,1,ME,both,0.59,0.41,,,,,,,,,,,,,,,,,,,Per Diem,2826.98,,Reimbursement is subject to Medicare Sequestration.,,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,,,,,,,,,,2826.98,2826.98, NF-OMEGA 3-6-9 ORAL LIQUID FILLED CAPSUL,250,RC,,,,1,EA,both,0.53,0.37,,,,,,,,,,,,,,,,,,,Other,0.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.12,0.12, NF-TURMERIC ORAL CAPSULE 500MG,250,RC,,,,1,ME,both,0.54,0.38,,,,,,,,,,,,,,,,,,,Other,0.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.12,0.12, MINOCYCLINE 100MG INJ,636,RC,,,,1,ME,both,1068.64,748.05,,,,,,,,,,,,,,,,,,,Other,230.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,230.4,230.4, NF-INSULIN LISPRO KWIKPEN SUBQ SOLN 100U,250,RC,,,,1,UN,both,84.86,59.4,,,,,,,,,,,,,,,,,,,Other,18.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.3,18.3, NF-FOLIC ACID ORAL TABLET 0.8MG,250,RC,,,,1,ME,both,6.75,4.73,,,,,,,,,,,,,,,,,,,Other,1.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.46,1.46, NF-LACTATED RINGER'S SOLUTION-POTASSIUM,121,RC,,,,1,ML,both,0.06,0.04,,,,,,,,,,,,,,,,,,,Per Diem,2826.98,,Reimbursement is subject to Medicare Sequestration.,,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,,,,,,,,,,2826.98,2826.98, NF-ICAPS AREDS ORAL TABLET,250,RC,,,,1,EA,both,0.48,0.34,,,,,,,,,,,,,,,,,,,Other,0.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.11,0.11, NF-ETODOLAC CAP 200MG,121,RC,,,,1,ME,both,5.75,4.03,,,,,,,,,,,,,,,,,,,Per Diem,2826.98,,Reimbursement is subject to Medicare Sequestration.,,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,,,,,,,,,,2826.98,2826.98, NF-STIOLTO RESPIMAT INH 2.5-2.5MCG/1ACT,250,RC,,,,1,EA,both,526.06,368.24,,,,,,,,,,,,,,,,,,,Other,113.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,113.42,113.42, NF-MAGNESIUM OXIDE TABLET 250MG,250,RC,,,,1,ME,both,0.08,0.06,,,,,,,,,,,,,,,,,,,Other,0.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.02,0.02, NF-CITALOPRAM HYDROBROMIDE ORAL TABLET 1,250,RC,,,,1,EA,both,9.83,6.88,,,,,,,,,,,,,,,,,,,Other,2.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.12,2.12, TIMOLOL 0.5% OPTH SOLN 5 ML,637,RC,,,,1,EA,both,841.25,588.88,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-ROSUVASTATIN CALCIUM CAP 5MG,250,RC,,,,1,ME,both,14.64,10.25,,,,,,,,,,,,,,,,,,,Other,3.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.16,3.16, NF-MOVE FREE OMEGA JOINT PLUS LIQ CAP,250,RC,,,,1,ME,both,3.1,2.17,,,,,,,,,,,,,,,,,,,Other,0.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.67,0.67, NF-SUPER B COMPLEX W/C CAPSULE,250,RC,,,,1,ME,both,0.2,0.14,,,,,,,,,,,,,,,,,,,Other,0.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.04,0.04, NF-HYDROCHLOROTHIAZIDE CAP 12.5MG,250,RC,,,,1,ME,both,1.7,1.19,,,,,,,,,,,,,,,,,,,Other,0.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.36,0.36, IVERMECTIN 3MG TAB,637,RC,,,,1,ME,both,21.37,14.96,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, BUDESONIDE 160MCG/FORMOTEROL 4.5MCG/ACT,637,RC,,,,1,EA,both,22.15,15.51,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-FARXIGA ORAL TABLET 10MG,250,RC,,,,1,ME,both,49.93,34.95,,,,,,,,,,,,,,,,,,,Other,10.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.76,10.76, NF-NOVOLIN N INJECTION 100U/ML,250,RC,,,,1,ML,both,66.1,46.27,,,,,,,,,,,,,,,,,,,Other,14.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.25,14.25, NF-NOVOLIN R INJECTION 100U/ML,250,RC,,,,1,ML,both,66.1,46.27,,,,,,,,,,,,,,,,,,,Other,14.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.25,14.25, NF-NOVOLIN N (NPH) SUBQ SUSP 100U/1ML,250,RC,,,,1,ML,both,6.38,4.47,,,,,,,,,,,,,,,,,,,Other,1.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.37,1.37, NF-NOVOLIN R INJ SOLN 100U/1ML,250,RC,,,,1,ML,both,66.1,46.27,,,,,,,,,,,,,,,,,,,Other,14.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.25,14.25, NF-KETOROLAC TROMETHAMINE TAB 10MG,250,RC,,,,1,ME,both,8.63,6.04,,,,,,,,,,,,,,,,,,,Other,1.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.86,1.86, NF-SUDAFED ORAL TABLET 30MG,250,RC,,,,1,ME,both,0.97,0.68,,,,,,,,,,,,,,,,,,,Other,0.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.21,0.21, NF-BREZTRI AEROSPHERE INH AER LIQ,250,RC,,,,1,ML,both,264.85,185.4,,,,,,,,,,,,,,,,,,,Other,57.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,57.1,57.1, NF-RIZATRIPTAN BENZOATE DIS TAB 10MG,250,RC,,,,1,ME,both,261.68,183.18,,,,,,,,,,,,,,,,,,,Other,56.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,56.42,56.42, NF-LORazepam INTENSOL CONCENTRATE 2MG/ML,250,RC,,,,1,ME,both,6.4,4.48,,,,,,,,,,,,,,,,,,,Other,1.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.38,1.38, NF-FLECAINIDE ACETATE ORAL TABLET 50MG,250,RC,,,,1,ME,both,8.08,5.66,,,,,,,,,,,,,,,,,,,Other,1.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.74,1.74, NF-TRAVATAN Z OPHTH SOLN 0.004%,250,RC,,,,1,ML,both,196.99,137.89,,,,,,,,,,,,,,,,,,,Other,42.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.47,42.47, NF-CITALOPRAM HYDROBROMIDE ORAL TAB 10MG,250,RC,,,,1,ME,both,9.73,6.81,,,,,,,,,,,,,,,,,,,Other,2.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.1,2.1, NF-CITALOPRAM HYDROBROMIDE ORAL TAB 20MG,250,RC,,,,1,ME,both,10.14,7.1,,,,,,,,,,,,,,,,,,,Other,2.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.19,2.19, NF-MAXALT ORAL TABLET 10MG,250,RC,,,,1,ME,both,143.05,100.14,,,,,,,,,,,,,,,,,,,Other,30.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,30.84,30.84, NF-HUMALOG KWIKPEN SUBQ SOLN 100U/1ML,250,RC,,,,1,ML,both,169.73,118.81,,,,,,,,,,,,,,,,,,,Other,36.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,36.59,36.59, NF-MAXALT-MLT DISINTEGRATING TAB 10MG,250,RC,,,,1,ME,both,175.54,122.88,,,,,,,,,,,,,,,,,,,Other,37.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.85,37.85, NF-TORSEMIDE ORAL TABLET 5MG,250,RC,,,,1,ME,both,2.54,1.78,,,,,,,,,,,,,,,,,,,Other,0.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.55,0.55, NF-VALSARTAN ORAL TABLET 160MG,250,RC,,,,1,ME,both,20.85,14.6,,,,,,,,,,,,,,,,,,,Other,4.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.5,4.5, NF-EPLERENONE ORAL TABLET 50MG,250,RC,,,,1,ME,both,16.66,11.66,,,,,,,,,,,,,,,,,,,Other,3.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.6,3.6, NF-ROCURONIUM BROMIDE IV SOLN 10MG/1ML,250,RC,,,,1,ME,both,3.53,2.47,,,,,,,,,,,,,,,,,,,Other,0.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.76,0.76, FLUORESCEIN 500MG/5ML INJ,250,RC,,,,1,ME,both,371.52,260.06,,,,,,,,,,,,,,,,,,,Other,80.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,80.1,80.1, NF-PREVAGEN ORAL CAP 10MG-50MCG,250,RC,,,,1,ME,both,3.8,2.66,,,,,,,,,,,,,,,,,,,Other,0.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.82,0.82, NF-AMITRIPTYLINE HCL ORAL TABLET 100MG,250,RC,,,,1,ME,both,10.16,7.11,,,,,,,,,,,,,,,,,,,Other,2.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.2,2.2, NF-NORTRIPTYLINE CAPSULE 10MG,250,RC,,,,1,ME,both,1.95,1.37,,,,,,,,,,,,,,,,,,,Other,0.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.42,0.42, APIXABAN 5MG TABLET,637,RC,,,,1,ME,both,52.15,36.51,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-MINOCYCLINE HCL CAP 100MG,250,RC,,,,1,ME,both,13.59,9.51,,,,,,,,,,,,,,,,,,,Other,2.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.93,2.93, NF-HYDROCHLOROTHIAZIDE ORAL TABLET 50MG,250,RC,,,,1,ME,both,0.96,0.67,,,,,,,,,,,,,,,,,,,Other,0.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.21,0.21, NF-COLESTIPOL ORAL TABLET 1GM,250,RC,,,,1,ME,both,6.8,4.76,,,,,,,,,,,,,,,,,,,Other,1.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.47,1.47, NF-COLESTIPOL HCL TAB 1GM,250,RC,,,,1,GM,both,4.95,3.47,,,,,,,,,,,,,,,,,,,Other,1.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.07,1.07, NF-LOVASTATIN ORAL TABLET 10MG,250,RC,,,,1,ME,both,5.38,3.77,,,,,,,,,,,,,,,,,,,Other,1.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.16,1.16, NF-AMIODARONE HCL ORAL TABLET 100MG,250,RC,,,,1,ME,both,29.72,20.8,,,,,,,,,,,,,,,,,,,Other,6.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.41,6.41, NF-MINOCYCLINE HCL,250,RC,,,,1,EA,both,24.08,16.86,,,,,,,,,,,,,,,,,,,Other,5.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.19,5.19, FLUVOXAMINE MALEATE 50MG TABLET,637,RC,,,,1,ME,both,11.07,7.75,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-CARBAMAZEPINE CAP ER 300MG,250,RC,,,,1,ME,both,2.59,1.81,,,,,,,,,,,,,,,,,,,Other,0.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.56,0.56, NF-QUINAPRIL HCL TAB 10MG,250,RC,,,,1,ME,both,23.36,16.35,,,,,,,,,,,,,,,,,,,Other,5.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.04,5.04, NF-CHLOROTHIAZIDE SOD IV PWD FOR SOLN 0.,250,RC,,,,1,ML,both,1428.96,1000.27,,,,,,,,,,,,,,,,,,,Other,308.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,308.08,308.08, NF-ALFUZOSIN HYDROCHLORIDE ER TABLET 10M,250,RC,,,,1,ME,both,16.85,11.8,,,,,,,,,,,,,,,,,,,Other,3.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.64,3.64, NF-FIBERCON ORAL TABLET 625MG,250,RC,,,,1,ME,both,0.42,0.29,,,,,,,,,,,,,,,,,,,Other,0.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.09,0.09, NF-CHLOROTHIAZIDE IV POWDER FOR SOLN 0.5,250,RC,,,,1,ML,both,1428.96,1000.27,,,,,,,,,,,,,,,,,,,Other,308.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,308.08,308.08, NF-NALTREXONE HCL ORAL TABLET 50MG,250,RC,,,,1,ME,both,10.94,7.66,,,,,,,,,,,,,,,,,,,Other,2.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.36,2.36, NF-KLONOPIN TABLET 1MG,250,RC,,,,1,ME,both,13.97,9.78,,,,,,,,,,,,,,,,,,,Other,3.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.01,3.01, REMDESIVIR 100MG INJ (VEKLURY),250,RC,,,,1,ME,both,2683.2,1878.24,,,,,,,,,,,,,,,,,,,Other,578.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,578.49,578.49, NF-FLUVOXAMINE MALEATE TAB 50MG,250,RC,,,,1,ME,both,10.29,7.2,,,,,,,,,,,,,,,,,,,Other,2.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.21,2.21, NF-FLUVOXAMINE MALEATE CAP ER 100MG,250,RC,,,,1,ME,both,40.73,28.51,,,,,,,,,,,,,,,,,,,Other,8.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.78,8.78, NF-ADVAIR DISKUS 100/50 DISK,250,RC,,,,1,EA,both,25.36,17.75,,,,,,,,,,,,,,,,,,,Other,5.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.47,5.47, NF-FEXOFENADINE HCL/PSEUDOEPHEDRINE HCL,250,RC,,,,1,EA,both,26.1,18.27,,,,,,,,,,,,,,,,,,,Other,5.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.63,5.63, VITAMIN C 1000 MG TAB (ASCORBIC ACID),637,RC,,,,1,ME,both,6.75,4.73,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-FLUVOXAMINE MALEATE TAB 50MG,250,RC,,,,1,ME,both,10.29,7.2,,,,,,,,,,,,,,,,,,,Other,2.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.21,2.21, NF-FEBUXOSTAT ORAL TABLET 40MG,250,RC,,,,1,ME,both,49.51,34.66,,,,,,,,,,,,,,,,,,,Other,10.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.67,10.67, NF-NASACORT ALLERGY 24HR NASAL SPRAY 55M,250,RC,,,,1,EA,both,6.46,4.52,,,,,,,,,,,,,,,,,,,Other,1.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.39,1.39, NF-JANUMET XR ORAL TAB ER 1000MG-100MG,250,RC,,,,1,ME,both,79.49,55.64,,,,,,,,,,,,,,,,,,,Other,17.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.14,17.14, NF-PRIMIDONE ORAL TABLET 250MG,250,RC,,,,1,ME,both,4.2,2.94,,,,,,,,,,,,,,,,,,,Other,0.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.9,0.9, NACL 0.9% + 40 MEQ KCL 1000 ML IV FLUID,636,RC,,,,1,ML,both,52.05,36.44,,,,,,,,,,,,,,,,,,,Other,11.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.22,11.22, NF-NAMZARIC CAP ER 7MG-10MG,250,RC,,,,1,ME,both,81.61,57.13,,,,,,,,,,,,,,,,,,,Other,17.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.59,17.59, NF-DOXYCYCLINE CAP 50MG,250,RC,,,,1,ME,both,5.8,4.06,,,,,,,,,,,,,,,,,,,Other,1.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.25,1.25, CEFTRIAXONE 2000MG INJ (ROCEPHIN),J0696,HCPCS,636,RC,,1,ME,both,392.62,274.83,,,,,,,,,,,,,,,,,,,Other,84.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.45,84.65, NF-MAYZENT ORAL TABLET 2MG,250,RC,,,,1,ME,both,1289.24,902.47,,,,,,,,,,,,,,,,,,,Other,277.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,277.96,277.96, NF-DALFAMPRIDINE ORAL TAB ER 10MG,250,RC,,,,1,ME,both,189.48,132.64,,,,,,,,,,,,,,,,,,,Other,40.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.86,40.86, NF-DILTIAZEM 24 HR CAP ER 240MG,250,RC,,,,1,ME,both,7.79,5.45,,,,,,,,,,,,,,,,,,,Other,1.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.68,1.68, NF-QUINAPRIL HCL/HCTZ ORAL TAB 20MG-25MG,250,RC,,,,1,ME,both,4.89,3.42,,,,,,,,,,,,,,,,,,,Other,1.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.06,1.06, NF-ROSUVASTATIN CALCIUM AVPAK TABLET 10M,250,RC,,,,1,ME,both,5.49,3.84,,,,,,,,,,,,,,,,,,,Other,1.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.19,1.19, NF-ETOMIDATE INTRAVENOUS SOLUTION 2MG/1M,250,RC,,,,1,ME,both,3.75,2.63,,,,,,,,,,,,,,,,,,,Other,0.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.81,0.81, NF-ROCURONIUM BROMIDE IV SOLN 10MG/1ML,250,RC,,,,1,ML,both,4.2,2.94,,,,,,,,,,,,,,,,,,,Other,0.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.9,0.9, NF-ROCURONIUM BROMIDE IV SOLN 10MG/1ML,250,RC,,,,1,ML,both,4.2,2.94,,,,,,,,,,,,,,,,,,,Other,0.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.9,0.9, NF-NEPRO WITH CARB STEADY ORAL SUSP,250,RC,,,,1,ML,both,0.06,0.04,,,,,,,,,,,,,,,,,,,Other,0.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.01,0.01, NF-MORPHINE SULFATE CAP ER 60MG,250,RC,,,,1,ME,both,44.82,31.37,,,,,,,,,,,,,,,,,,,Other,9.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.66,9.66, NF-MORPHINE SULFATE CAP ER 30MG,250,RC,,,,1,ME,both,22.72,15.9,,,,,,,,,,,,,,,,,,,Other,4.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.9,4.9, NF-EUTHYROX ORAL TABLET 75MCG,250,RC,,,,1,ME,both,2.19,1.53,,,,,,,,,,,,,,,,,,,Other,0.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.47,0.47, NF-ALTACE ORAL CAPSULE 10MG,250,RC,,,,1,ME,both,4.82,3.37,,,,,,,,,,,,,,,,,,,Other,1.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.04,1.04, NF-TRIAMTERENE AND HCTZ TABLET 37.5MG-25,250,RC,,,,1,ME,both,1.57,1.1,,,,,,,,,,,,,,,,,,,Other,0.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.34,0.34, NF-MORPHINE SULFATE CAP ER 60MG,250,RC,,,,1,ME,both,45.44,31.81,,,,,,,,,,,,,,,,,,,Other,9.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.8,9.8, NF-MORPHINE SULFATE IR ORAL TABLET 30MG,250,RC,,,,1,ME,both,7.3,5.11,,,,,,,,,,,,,,,,,,,Other,1.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.58,1.58, NF-LANSOPRAZOLE PWD FOR SUSP 3MG/1ML,250,RC,,,,1,ME,both,1.84,1.29,,,,,,,,,,,,,,,,,,,Other,0.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.39,0.39, LIDOCAINE JELLY 2% 6ML (XYLOCAINE),250,RC,,,,1,ME,both,36.12,25.28,,,,,,,,,,,,,,,,,,,Other,7.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.79,7.79, NF-SIMVASTATIN ORAL TABLET 40MG,250,RC,,,,1,ME,both,19.57,13.7,,,,,,,,,,,,,,,,,,,Other,4.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.22,4.22, NF-PANTOPRAZOLE 20MG TABLET,250,RC,,,,1,ME,both,15.94,11.16,,,,,,,,,,,,,,,,,,,Other,3.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.44,3.44, NF-SUBOXONE SL FILM 8MG-2MG,250,RC,,,,1,ME,both,43.12,30.18,,,,,,,,,,,,,,,,,,,Other,9.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.3,9.3, NF-PROCTOSOL-HC RECTAL CREAM 2.5%,250,RC,,,,1,EA,both,3.52,2.46,,,,,,,,,,,,,,,,,,,Other,0.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.75,0.75, NF-TRULICITY SUBQ SOLN 1.5MG/0.5ML,250,RC,,,,1,ME,both,2127.74,1489.42,,,,,,,,,,,,,,,,,,,Other,458.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,458.74,458.74, NF-MYLANTA TONIGHT ORAL SUSPENSION,637,RC,,,,1,ML,both,0.07,0.05,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-ALPHAGAN P OPHTH SOLN 0.15%,250,RC,,,,1,ML,both,189.52,132.66,,,,,,,,,,,,,,,,,,,Other,40.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.86,40.86, NF-CARTIA XT ORAL 24 HR CAP ER 120MG,250,RC,,,,1,ME,both,4.89,3.42,,,,,,,,,,,,,,,,,,,Other,1.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.06,1.06, NF-ROSUVASTATIN CALCIUM CAP 10MG,250,RC,,,,1,ME,both,14.64,10.25,,,,,,,,,,,,,,,,,,,Other,3.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.16,3.16, NF-ADVAIR HFA 230/21 INH AER 230MCG-21MC,250,RC,,,,1,ME,both,194.73,136.31,,,,,,,,,,,,,,,,,,,Other,41.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.98,41.98, NF-LORAZEPAM ORAL TABLET 1MG,250,RC,,,,1,ME,both,3.63,2.54,,,,,,,,,,,,,,,,,,,Other,0.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.78,0.78, KCENTRA 548 IU,J7168,HCPCS,636,RC,,1,UN,both,8435.91,5905.14,,,,,,,,,,,,,,,,,,,Other,1818.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1818.78,1818.78, NF-ROSUVASTATIN CALCIUM ORAL TABLET 20MG,250,RC,,,,1,ME,both,34.45,24.12,,,,,,,,,,,,,,,,,,,Other,7.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.43,7.43, NF-SODIUM CHLORIDE,250,RC,,,,1,ML,both,0.02,0.01,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-ANTIBIOTIC OINTMENT,250,RC,,,,1,EA,both,0.63,0.44,,,,,,,,,,,,,,,,,,,Other,0.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.14,0.14, NF-ZOSYN IV SOLUTION 4GM-0.5GM/100ML,250,RC,,,,1,ME,both,1.22,0.85,,,,,,,,,,,,,,,,,,,Other,0.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.26,0.26, PIPERACILLIN/TAZOBACTAM 4GM/.5GM INJ,J2543,HCPCS,636,RC,,1,ME,both,118.47,82.93,,,,,,,,,,,,,,,,,,,Other,25.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.07,25.54, NF-FOSINOPRIL SODIUM ORAL TABLET 20MG,250,RC,,,,1,ME,both,4.76,3.33,,,,,,,,,,,,,,,,,,,Other,1.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.03,1.03, NF-8HR ARTHRITIS PAIN RELIEF TABER 650MG,250,RC,,,,1,ME,both,0.3,0.21,,,,,,,,,,,,,,,,,,,Other,0.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.07,0.07, NF-VISION HEALTH ORAL LIQUID CAPSULE,250,RC,,,,1,ME,both,0.63,0.44,,,,,,,,,,,,,,,,,,,Other,0.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.14,0.14, NF-NEXIUM 24HR ORAL TABLET DR 20MG,250,RC,,,,1,ME,both,3.71,2.6,,,,,,,,,,,,,,,,,,,Other,0.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.8,0.8, NF-VIT B COMPLEX AND IRON-VIT B COMPLEX,250,RC,,,,1,EA,both,10.29,7.2,,,,,,,,,,,,,,,,,,,Other,2.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.21,2.21, NF-VIT. B COMPLEX AND MINERAL-VIT. B COM,250,RC,,,,1,EA,both,29.78,20.85,,,,,,,,,,,,,,,,,,,Other,6.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.42,6.42, NF-FLAX SEED OIL CAPSULE 1000MG,250,RC,,,,1,ME,both,0.32,0.22,,,,,,,,,,,,,,,,,,,Other,0.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.07,0.07, NF-MORPHINE SULFATE CAP ER 30MG,250,RC,,,,1,ME,both,25.95,18.17,,,,,,,,,,,,,,,,,,,Other,5.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.6,5.6, NF-MORPHINE SULFATE IR ORAL TABLET 30MG,250,RC,,,,1,ME,both,3.67,2.57,,,,,,,,,,,,,,,,,,,Other,0.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.79,0.79, NF-AMOXICILLIN CAP 500MG,250,RC,,,,1,ME,both,1.56,1.09,,,,,,,,,,,,,,,,,,,Other,0.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.33,0.33, NF-METFORMIN HCL ORAL TAB ER 1000MG,250,RC,,,,1,ME,both,480.95,336.67,,,,,,,,,,,,,,,,,,,Other,103.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,103.69,103.69, NF-CELEXA TAB 20MG,250,RC,,,,1,ME,both,19.34,13.54,,,,,,,,,,,,,,,,,,,Other,4.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.16,4.16, NF-PRAZOSIN HCL CAP 5MG,250,RC,,,,1,ME,both,8.73,6.11,,,,,,,,,,,,,,,,,,,Other,1.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.88,1.88, NF-cycloSPORINE OPHTH EMULSION 0.05%,250,RC,,,,1,EA,both,51.65,36.16,,,,,,,,,,,,,,,,,,,Other,11.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.13,11.13, NF-PREGABALIN CAP 200MG,250,RC,,,,1,ME,both,43.23,30.26,,,,,,,,,,,,,,,,,,,Other,9.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.32,9.32, NF-PROTONIX INJECTION 40MG,250,RC,,,,1,ME,both,24.36,17.05,,,,,,,,,,,,,,,,,,,Other,5.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.25,5.25, NF-ERLEADA ORAL TABLET 60MG,250,RC,,,,1,ME,both,541.05,378.74,,,,,,,,,,,,,,,,,,,Other,116.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,116.65,116.65, CEFAZOLIN 2000MG INJ (ANCEF),J0687,HCPCS,636,RC,,1,ME,both,31.44,22.01,,,,,,,,,,,,,,,,,,,Other,6.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.86,6.78, NF-SERTRALINE HCL ORAL TABLET 25MG,250,RC,,,,1,ME,both,11.01,7.71,,,,,,,,,,,,,,,,,,,Other,2.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.37,2.37, NF-ESCITALOPRAM ORAL TABLET 5MG,250,RC,,,,1,ME,both,19.92,13.94,,,,,,,,,,,,,,,,,,,Other,4.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.29,4.29, NF-COLACE LIQ CAP 50MG,250,RC,,,,1,ME,both,1.17,0.82,,,,,,,,,,,,,,,,,,,Other,0.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.25,0.25, NF-FLOVENT DISKUS INH PWD 100MCG/1ACT,250,RC,,,,1,EA,both,16.36,11.45,,,,,,,,,,,,,,,,,,,Other,3.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.53,3.53, NF-IPRATROPIUM BROMIDE NASAL SPRAY 0.06%,250,RC,,,,1,EA,both,20.54,14.38,,,,,,,,,,,,,,,,,,,Other,4.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.43,4.43, NF-LOSARTAN AND HYDROCHLOROTHIAZIDE 50-1,250,RC,,,,1,ME,both,10.01,7.01,,,,,,,,,,,,,,,,,,,Other,2.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.16,2.16, NF-PREDNISOLONE ACETATE OPHTH SUSP 1%,250,RC,,,,1,ML,both,44.22,30.95,,,,,,,,,,,,,,,,,,,Other,9.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.54,9.54, NF-MURO-128 OPHTH SOLUTION 5%,250,RC,,,,1,ML,both,27.2,19.04,,,,,,,,,,,,,,,,,,,Other,5.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.86,5.86, NF-BRIMONIDINE-TIMOLOL OPHTH SOLN 0.2%-0,250,RC,,,,1,EA,both,177.31,124.12,,,,,,,,,,,,,,,,,,,Other,38.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,38.23,38.23, NF-HYDRALAZINE HCL ORAL TAB 50MG,250,RC,,,,1,ME,both,2.42,1.69,,,,,,,,,,,,,,,,,,,Other,0.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.52,0.52, NF-FLUOXETINE HCL CAP 20MG,250,RC,,,,1,ME,both,25.86,18.1,,,,,,,,,,,,,,,,,,,Other,5.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.58,5.58, NF-TRELEGY ELLIPTA 200/62.5/25MCG/INH,250,RC,,,,1,EA,both,49.53,34.67,,,,,,,,,,,,,,,,,,,Other,10.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.68,10.68, NF-PRADAXA CAP 150MG,250,RC,,,,1,ME,both,32.05,22.44,,,,,,,,,,,,,,,,,,,Other,6.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.91,6.91, NF-MESALAMINE CAP DR 400MG,250,RC,,,,1,ME,both,18.62,13.03,,,,,,,,,,,,,,,,,,,Other,4.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.02,4.02, NF-POTASSIUM CHLORIDE ORAL SOLN 40MEQ/15,250,RC,,,,1,ML,both,6.5,4.55,,,,,,,,,,,,,,,,,,,Other,1.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.4,1.4, NF-PEPTIDE 1.5 SUSPENSION,250,RC,,,,1,ME,both,0.09,0.06,,,,,,,,,,,,,,,,,,,Other,0.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.02,0.02, KETAMINE 500MG/ 5ML INJ (KETALAR),250,RC,,,,1,ME,both,68.83,48.18,,,,,,,,,,,,,,,,,,,Other,14.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.84,14.84, NF-OFLOXACIN OPHTHALMIC SOLUTION 0.3%,250,RC,,,,1,EA,both,16.75,11.73,,,,,,,,,,,,,,,,,,,Other,3.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.62,3.62, NF-PREDNISOLONE ACETATE OPHTH SUSP 1%,250,RC,,,,1,ML,both,44.22,30.95,,,,,,,,,,,,,,,,,,,Other,9.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.54,9.54, NF-D-MANNOSE ORAL CAPSULE 300MG,250,RC,,,,1,ME,both,0.86,0.6,,,,,,,,,,,,,,,,,,,Other,0.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.19,0.19, NF-GLUCOSAMINE COMPLEX TABLET,250,RC,,,,1,EA,both,0.53,0.37,,,,,,,,,,,,,,,,,,,Other,0.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.12,0.12, NF-TURMERIC CAP 400MG,250,RC,,,,1,ME,both,0.39,0.27,,,,,,,,,,,,,,,,,,,Other,0.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.09,0.09, LUPRON DEPOT INJ 30MG FOR 4MONTH ADMIN,J9217,HCPCS,636,RC,,1,ME,both,38267.68,26787.38,,,,,,,,,,,,,,,,,,,Other,8250.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,167.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,167.36,8250.51, NF-PRAVASTATIN ORAL TABLET 20MG,250,RC,,,,1,ME,both,13.07,9.15,,,,,,,,,,,,,,,,,,,Other,2.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.82,2.82, NF-CRESTOR ORAL TABLET 40MG,250,RC,,,,1,ME,both,22.19,15.53,,,,,,,,,,,,,,,,,,,Other,4.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.78,4.78, NF-APPLE CIDER VINEGAR PLUS ORAL TABLET,250,RC,,,,1,ME,both,0.61,0.43,,,,,,,,,,,,,,,,,,,Other,0.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.13,0.13, NF-ESTROVEN ENERGY ORAL TABLET,637,RC,,,,1,EA,both,2.64,1.85,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-SPRINTEC TAB 35MCG-0.25MG,250,RC,,,,1,ME,both,4.6,3.22,,,,,,,,,,,,,,,,,,,Other,0.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.99,0.99, NF-IRBESARTAN ORAL TABLET 300MG,250,RC,,,,1,ME,both,14.77,10.34,,,,,,,,,,,,,,,,,,,Other,3.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.18,3.18, NF-AMLODIPINE-OLMESARTAN ORAL TAB 10MG-4,250,RC,,,,1,ME,both,39.61,27.73,,,,,,,,,,,,,,,,,,,Other,8.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.54,8.54, NF-PROVENTIL HFA INH SUSP 0.09MG/1ACT,250,RC,,,,1,ME,both,53.99,37.79,,,,,,,,,,,,,,,,,,,Other,11.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.64,11.64, NF-PRAVASTATIN ORAL TABLET 20MG,250,RC,,,,1,ME,both,13.07,9.15,,,,,,,,,,,,,,,,,,,Other,2.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.82,2.82, NF-PRAVACHOL ORAL TABLET 40MG,250,RC,,,,1,ME,both,26.91,18.84,,,,,,,,,,,,,,,,,,,Other,5.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.8,5.8, NF-PRAVASTATIN SODIUM ORAL TABLET 10MG,250,RC,,,,1,ME,both,12.86,9,,,,,,,,,,,,,,,,,,,Other,2.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.77,2.77, NF-PRAVASTATIN ORAL TABLET 20MG,250,RC,,,,1,ME,both,13.07,9.15,,,,,,,,,,,,,,,,,,,Other,2.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.82,2.82, NF-CARBIDOPA AND LEVODOPA TAB ER 50MG-20,250,RC,,,,1,ME,both,7.22,5.05,,,,,,,,,,,,,,,,,,,Other,1.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.56,1.56, NF-EYE DROPS OPHTHALMIC SOLUTION 0.05%,250,RC,,,,1,EA,both,0.51,0.36,,,,,,,,,,,,,,,,,,,Other,0.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.11,0.11, NF-AMIODARONE HCL ORAL TABLET 400MG,250,RC,,,,1,ME,both,22.12,15.48,,,,,,,,,,,,,,,,,,,Other,4.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.77,4.77, NF-LOSARTAN/HCTZ ORAL TABLET 50MG-12.5MG,250,RC,,,,1,ME,both,10.01,7.01,,,,,,,,,,,,,,,,,,,Other,2.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.16,2.16, NF-BUDESONIDE CAP DR 3MG,250,RC,,,,1,ME,both,65.85,46.1,,,,,,,,,,,,,,,,,,,Other,14.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.2,14.2, MICAFUNGIN 100 MG IV,636,RC,,,,1,ME,both,964.92,675.44,,,,,,,,,,,,,,,,,,,Other,208.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,208.03,208.03, BUDESONIDE 3MG CAP,637,RC,,,,1,ME,both,69.66,48.76,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-PAROXETINE HCL AVPAK ORAL TABLET 30MG,250,RC,,,,1,ME,both,10.87,7.61,,,,,,,,,,,,,,,,,,,Other,2.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.34,2.34, NF-LACRI-LUBE S.O.P. OPHTH OINTMENT,250,RC,,,,1,EA,both,12.09,8.46,,,,,,,,,,,,,,,,,,,Other,2.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.61,2.61, NF-ALEVE ORAL TABLET 220MG,250,RC,,,,1,ME,both,0.51,0.36,,,,,,,,,,,,,,,,,,,Other,0.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.11,0.11, NF-ROSUVASTATIN CALCIUM CAP 20MG,250,RC,,,,1,ME,both,15.87,11.11,,,,,,,,,,,,,,,,,,,Other,3.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.42,3.42, NF-SYNJARDY XR ORAL TAB ER 25MG-1000MG,250,RC,,,,1,ME,both,91.28,63.9,,,,,,,,,,,,,,,,,,,Other,19.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.68,19.68, NF-RHOPRESSA OPHTHALMIC SOLUTION 0.02%,250,RC,,,,1,ME,both,570.43,399.3,,,,,,,,,,,,,,,,,,,Other,122.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,122.98,122.98, NF-PROGESTERONE LIQ CAP 100MG,250,RC,,,,1,ME,both,10.27,7.19,,,,,,,,,,,,,,,,,,,Other,2.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.21,2.21, NF-ESTRADIOL GEL 0.06%,250,RC,,,,1,ME,both,17.84,12.49,,,,,,,,,,,,,,,,,,,Other,3.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.84,3.84, NF-TESTOSTERONE CYPIONATE IM OIL 100MG/1,250,RC,,,,1,ME,both,37.04,25.93,,,,,,,,,,,,,,,,,,,Other,7.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.99,7.99, NF-ORAJEL INSTANT PAIN RELIEF GEL,250,RC,,,,1,ME,both,2.74,1.92,,,,,,,,,,,,,,,,,,,Other,0.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.59,0.59, NF-ORAJEL INSTANT PAIN RELIEF GEL,250,RC,,,,1,EA,both,2.74,1.92,,,,,,,,,,,,,,,,,,,Other,0.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.59,0.59, NF-ORAJEL MOUTH SORE MEDICINE,250,RC,,,,1,EA,both,5.39,3.77,,,,,,,,,,,,,,,,,,,Other,1.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.17,1.17, NF-NOVOLIN N (NPH) SUBQ SUSP 100U/1ML,250,RC,,,,1,ML,both,66.1,46.27,,,,,,,,,,,,,,,,,,,Other,14.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.25,14.25, NF-BENICAR ORAL TABLET 40MG,250,RC,,,,1,ME,both,18.07,12.65,,,,,,,,,,,,,,,,,,,Other,3.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.9,3.9, NF-VITAMIN D3 & K 1000U/100MCG,250,RC,,,,1,UN,both,0.15,0.11,,,,,,,,,,,,,,,,,,,Other,0.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.03,0.03, NF-NORTRIPTYLINE HCL CAP 10MG,250,RC,,,,1,ME,both,0.5,0.35,,,,,,,,,,,,,,,,,,,Other,0.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.11,0.11, NF-INDOMETHACIN CAP 50MG,250,RC,,,,1,ME,both,4.19,2.93,,,,,,,,,,,,,,,,,,,Other,0.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.9,0.9, NF-NOVOLIN N (NPH) SUBQ SUSP 100U/1ML,250,RC,,,,1,ML,both,6.38,4.47,,,,,,,,,,,,,,,,,,,Other,1.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.37,1.37, LIDOCAINE W/EPI INJ 1.5% 10ML,250,RC,,,,1,ML,both,42.98,30.09,,,,,,,,,,,,,,,,,,,Other,9.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.27,9.27, NF-LASIX TAB 80MG,250,RC,,,,1,ME,both,6.49,4.54,,,,,,,,,,,,,,,,,,,Other,1.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.4,1.4, NF-SALIVAMAX MM PWD FOR SOLN,250,RC,,,,1,EA,both,46.67,32.67,,,,,,,,,,,,,,,,,,,Other,10.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.06,10.06, NF-TABRECTA ORAL TAB 200MG,250,RC,,,,1,ME,both,856.23,599.36,,,,,,,,,,,,,,,,,,,Other,184.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,184.6,184.6, NF-CEFEPIME HCL IV SOLN 1GM/50ML,250,RC,,,,1,ML,both,2.55,1.79,,,,,,,,,,,,,,,,,,,Other,0.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.55,0.55, NF-CEFEPIME HCL INJ PWD FOR SOLN 1GM,250,RC,,,,1,GM,both,29.23,20.46,,,,,,,,,,,,,,,,,,,Other,6.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.3,6.3, NF-HYDROXYZINE PAMOATE CAP 100MG,250,RC,,,,1,ME,both,4.76,3.33,,,,,,,,,,,,,,,,,,,Other,1.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.03,1.03, NF-ATIVAN ORAL TABLET 0.5MG,250,RC,,,,1,ME,both,149.03,104.32,,,,,,,,,,,,,,,,,,,Other,32.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.13,32.13, NF-BISOPROLOL-HYDROCHLOROTHIAZIDE TAB 2.,250,RC,,,,1,ME,both,5.52,3.86,,,,,,,,,,,,,,,,,,,Other,1.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.19,1.19, NF-CARVEDILOL ORAL TABLET 25MG,250,RC,,,,1,ME,both,7.79,5.45,,,,,,,,,,,,,,,,,,,Other,1.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.68,1.68, NF-OLMESARTAN MEDOXOMIL ORAL TAB 40MG,250,RC,,,,1,ME,both,38.43,26.9,,,,,,,,,,,,,,,,,,,Other,8.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.28,8.28, NF-MAGNESIUM CITRATE SOLN 1.75GM/30ML,250,RC,,,,1,ME,both,0.33,0.23,,,,,,,,,,,,,,,,,,,Other,0.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.07,0.07, NF-IFE-BIMIX 30/1 30MG-1MG/1ML,250,RC,,,,1,ME,both,300.36,210.25,,,,,,,,,,,,,,,,,,,Other,64.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,64.76,64.76, NF-MAGNESIUM GLYCINATE POWDER,250,RC,,,,1,EA,both,2.66,1.86,,,,,,,,,,,,,,,,,,,Other,0.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.58,0.58, NF-MODAFINIL ORAL TABLET 100MG,250,RC,,,,1,ME,both,88.08,61.66,,,,,,,,,,,,,,,,,,,Other,18.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.99,18.99, NF-CHLORPHENIRAMINE MALEATE ORAL TABLET,250,RC,,,,1,ME,both,0.33,0.23,,,,,,,,,,,,,,,,,,,Other,0.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.07,0.07, NF-LOPERAMIDE HCL CAP 2MG,250,RC,,,,1,ME,both,5.33,3.73,,,,,,,,,,,,,,,,,,,Other,1.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.15,1.15, NF-PRIMIDONE ORAL TABLET 50MG,250,RC,,,,1,ME,both,6.19,4.33,,,,,,,,,,,,,,,,,,,Other,1.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.33,1.33, NF-PROGESTERONE LIQ CAP 100MG,250,RC,,,,1,ME,both,20.68,14.48,,,,,,,,,,,,,,,,,,,Other,4.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.46,4.46, NF-LIOTHYRONINE SODIUM ORAL TABLET 5MCG,250,RC,,,,1,ME,both,7.56,5.29,,,,,,,,,,,,,,,,,,,Other,1.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.63,1.63, NF-LIOTHYRONINE SODIUM ORAL TABLET 5MCG,250,RC,,,,1,ME,both,6.68,4.68,,,,,,,,,,,,,,,,,,,Other,1.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.44,1.44, NF-LEVOTHYROXINE ORAL TABLET 100MCG,250,RC,,,,1,ME,both,2.25,1.58,,,,,,,,,,,,,,,,,,,Other,0.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.49,0.49, NF-1ST TIER UNIFINE PENTIPS NEEDLE DEVIC,250,RC,,,,1,EA,both,1.04,0.73,,,,,,,,,,,,,,,,,,,Other,0.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.23,0.23, NF-AMLODIPINE & BENAZEPRIL HCL 5MG-40MG,250,RC,,,,1,ME,both,17.82,12.47,,,,,,,,,,,,,,,,,,,Other,3.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.84,3.84, NF-ACCOLATE ORAL TABLET 20MG,250,RC,,,,1,ME,both,8.22,5.75,,,,,,,,,,,,,,,,,,,Other,1.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.77,1.77, NF-AZELASTINE HCL NASAL SPRAY 137MCG/1AC,250,RC,,,,1,EA,both,14.03,9.82,,,,,,,,,,,,,,,,,,,Other,3.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.03,3.03, NF-TRAZODONE HCL ORAL TABLET 150MG,250,RC,,,,1,ME,both,11.17,7.82,,,,,,,,,,,,,,,,,,,Other,2.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.41,2.41, NF-OXYCONTIN TAB ER 20MG,250,RC,,,,1,ME,both,28.14,19.7,,,,,,,,,,,,,,,,,,,Other,6.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.07,6.07, NF-MICARDIS ORAL TABLET 20MG,250,RC,,,,1,ME,both,22.44,15.71,,,,,,,,,,,,,,,,,,,Other,4.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.84,4.84, NF-DECADRON ORAL TABLET 4MG,250,RC,,,,1,ME,both,19.03,13.32,,,,,,,,,,,,,,,,,,,Other,4.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.11,4.11, DEXMEDETOMIDINE 180MCG SL TABLET,637,RC,,,,1,ME,both,541.8,379.26,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, Clindamycin/PREMIX IVPB: 600MG/50ML,J0736,HCPCS,636,RC,,1,ME,both,55.11,38.58,,,,,,,,,,,,,,,,,,,Other,11.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.87,11.88, Cefepime/NS IVPB: 1000MG/100ML,250,RC,,,,1,ME,both,395.14,276.6,,,,,,,,,,,,,,,,,,,Other,85.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,85.19,85.19, FORMOTEROL FUM NEB 20MCG/2ML (PERFOMIST),636,RC,,,,1,ME,both,95.91,67.14,,,,,,,,,,,,,,,,,,,Other,20.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.68,20.68, NF-PHENTERMINE HCL CAP 37.5MG,250,RC,,,,1,ME,both,6.28,4.4,,,,,,,,,,,,,,,,,,,Other,1.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.35,1.35, PYRIDOSTIGMINE BROMIDE 60MG,637,RC,,,,1,ME,both,6.75,4.73,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-PYRIDOSTIGMINE BROMIDE ORAL TABLET 60,250,RC,,,,1,ME,both,5.1,3.57,,,,,,,,,,,,,,,,,,,Other,1.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.1,1.1, NF-PRAZOSIN HCL CAP 1MG,250,RC,,,,1,ME,both,7.1,4.97,,,,,,,,,,,,,,,,,,,Other,1.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.53,1.53, NF-OXCARBAZEPINE ORAL TABLET 150MG,250,RC,,,,1,ME,both,5.78,4.05,,,,,,,,,,,,,,,,,,,Other,1.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.24,1.24, NF-DILT-XR 24 HOUR ORAL CAPSULE ER 240MG,250,RC,,,,1,ME,both,5.73,4.01,,,,,,,,,,,,,,,,,,,Other,1.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.23,1.23, NF-SEROQUEL XR ORAL TAB ER 150MG,250,RC,,,,1,ME,both,70.78,49.55,,,,,,,,,,,,,,,,,,,Other,15.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.26,15.26, NF-COQ10 RX ORAL CAPSULE 200MG,250,RC,,,,1,ME,both,9.33,6.53,,,,,,,,,,,,,,,,,,,Other,2.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.01,2.01, NF-BISOPROLOL FUMARATE ORAL TABLET 10MG,250,RC,,,,1,ME,both,9.01,6.31,,,,,,,,,,,,,,,,,,,Other,1.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.94,1.94, NF-FLUTICASONE FUROATE/VILANTEROL ELLIPT,250,RC,,,,1,EA,both,29.17,20.42,,,,,,,,,,,,,,,,,,,Other,6.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.29,6.29, NF-BUMETANIDE ORAL TABLET 0.5MG,250,RC,,,,1,ME,both,4.33,3.03,,,,,,,,,,,,,,,,,,,Other,0.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.93,0.93, NF-CALTRATE 600 + D ORAL TABLET 600MG-20,250,RC,,,,1,ME,both,0.51,0.36,,,,,,,,,,,,,,,,,,,Other,0.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.11,0.11, NF-MESALAMINE CAP ER 0.375GM,250,RC,,,,1,ME,both,20.41,14.29,,,,,,,,,,,,,,,,,,,Other,4.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.4,4.4, NF-PRAVASTATIN ORAL TABLET 20MG,250,RC,,,,1,ME,both,13.07,9.15,,,,,,,,,,,,,,,,,,,Other,2.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.82,2.82, NF-MORPHINE SULFATE CAP ER 30MG,250,RC,,,,1,ME,both,22.46,15.72,,,,,,,,,,,,,,,,,,,Other,4.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.84,4.84, NF-ENTRESTO TAB 24MG-26MG,250,RC,,,,1,ME,both,53.44,37.41,,,,,,,,,,,,,,,,,,,Other,11.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.52,11.52, NF-ENTRESTO ORAL TABLET 24MG-26MG,250,RC,,,,1,ME,both,37,25.9,,,,,,,,,,,,,,,,,,,Other,7.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.98,7.98, NF-TAGRISSO ORAL TABLET 80MG,250,RC,,,,1,ME,both,2581.55,1807.09,,,,,,,,,,,,,,,,,,,Other,556.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,556.58,556.58, NF-CELEXA TABLET 40MG,250,RC,,,,1,ME,both,18.59,13.01,,,,,,,,,,,,,,,,,,,Other,4.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.01,4.01, NF-CELEXA TAB 40MG,250,RC,,,,1,ME,both,47.39,33.17,,,,,,,,,,,,,,,,,,,Other,10.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.22,10.22, NF-RYTARY CAP ER 48.75MG-195MG,250,RC,,,,1,ME,both,18.47,12.93,,,,,,,,,,,,,,,,,,,Other,3.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.98,3.98, NF-CELEXA TAB 10MG,250,RC,,,,1,ME,both,43.57,30.5,,,,,,,,,,,,,,,,,,,Other,9.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.4,9.4, NF-ASPIRIN CAP ER 24HR 162.5MG,250,RC,,,,1,ME,both,28.8,20.16,,,,,,,,,,,,,,,,,,,Other,6.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.21,6.21, NF-ASPIRIN-CALCIUM CARBONATE TAB 81MG-77,250,RC,,,,1,ME,both,0.51,0.36,,,,,,,,,,,,,,,,,,,Other,0.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.11,0.11, NF-DENOSUMAB SUBQ SOLN 60MG/1ML,250,RC,,,,1,ME,both,7508.68,5256.08,,,,,,,,,,,,,,,,,,,Other,1618.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1618.87,1618.87, NF-PANTOPRAZOLE SODIUM AVPAK TAB DR 20MG,250,RC,,,,1,ME,both,15.94,11.16,,,,,,,,,,,,,,,,,,,Other,3.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.44,3.44, NF-ERLEADA ORAL TABLET 240MG,250,RC,,,,1,ME,both,2272.41,1590.69,,,,,,,,,,,,,,,,,,,Other,489.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,489.93,489.93, NF-CALAMINE TOPICAL LOTION 8%-8%,250,RC,,,,1,EA,both,0.09,0.06,,,,,,,,,,,,,,,,,,,Other,0.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.02,0.02, NF-CALAMINE PHENOLATED LOTION 8%-1%,250,RC,,,,1,EA,both,0.09,0.06,,,,,,,,,,,,,,,,,,,Other,0.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.02,0.02, NF-TRELEGY ELLIPTA 200/62.5/25MCG/INH,250,RC,,,,1,EA,both,51.08,35.76,,,,,,,,,,,,,,,,,,,Other,11.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.02,11.02, NF-BENAZEPRIL HCL ORAL TABLET 40MG,250,RC,,,,1,ME,both,4.2,2.94,,,,,,,,,,,,,,,,,,,Other,0.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.9,0.9, NF-LOTRISONE CREAM,250,RC,,,,1,EA,both,5.51,3.86,,,,,,,,,,,,,,,,,,,Other,1.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.19,1.19, NF-MEXILETINE HCL CAP 150MG,250,RC,,,,1,ME,both,3.62,2.53,,,,,,,,,,,,,,,,,,,Other,0.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.78,0.78, NF-ZESTORETIC ORAL TABLET 10MG-12.5MG,250,RC,,,,1,ME,both,5.12,3.58,,,,,,,,,,,,,,,,,,,Other,1.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.11,1.11, Dexmedetomidin/PREMIX IVPB: 400MCG/100ML,250,RC,,,,1,ME,both,412.8,288.96,,,,,,,,,,,,,,,,,,,Other,89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,89,89, NF-ENALAPRIL MALEATE ORAL TABLET 10MG,250,RC,,,,1,ME,both,6.41,4.49,,,,,,,,,,,,,,,,,,,Other,1.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.38,1.38, NF-HUMULIN R CONCENTRATE U-500 INJ 500U/,250,RC,,,,1,UN,both,356.88,249.82,,,,,,,,,,,,,,,,,,,Other,76.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,76.94,76.94, NF-NORTRIPTYLINE HCL CAP 10MG,250,RC,,,,1,ME,both,1.38,0.97,,,,,,,,,,,,,,,,,,,Other,0.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.29,0.29, NF-NORTREL 7/7/7 ORAL TABLET,250,RC,,,,1,ME,both,11.35,7.95,,,,,,,,,,,,,,,,,,,Other,2.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.45,2.45, NF-NORTRIPTYLINE HCL AVPAK CAP 50MG,250,RC,,,,1,ME,both,2.51,1.76,,,,,,,,,,,,,,,,,,,Other,0.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.54,0.54, NF-PROVIGIL ORAL TABLET 100MG,250,RC,,,,1,ME,both,226.93,158.85,,,,,,,,,,,,,,,,,,,Other,48.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,48.92,48.92, NF-DUODERM SIGNAL TAPERED EDGE DRSG DEVI,250,RC,,,,1,ME,both,85.91,60.14,,,,,,,,,,,,,,,,,,,Other,18.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.52,18.52, NF-RYTARY CAP ER 23.75MG-95MG,250,RC,,,,1,ME,both,18.47,12.93,,,,,,,,,,,,,,,,,,,Other,3.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.98,3.98, NF-BREO ELLIPTA INH PWD 100MCG-25MCG/1AC,250,RC,,,,1,ME,both,26.11,18.28,,,,,,,,,,,,,,,,,,,Other,5.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.63,5.63, NF-ATACAND ORAL TABLET 16MG,250,RC,,,,1,ME,both,9.84,6.89,,,,,,,,,,,,,,,,,,,Other,2.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.12,2.12, NF-DIAZEPAM ORAL TABLET 2MG,250,RC,,,,1,ME,both,3.04,2.13,,,,,,,,,,,,,,,,,,,Other,0.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.66,0.66, NF-LEVALBUTEROL TARTRATE 0.045MG/1ACT,250,RC,,,,1,EA,both,19.65,13.76,,,,,,,,,,,,,,,,,,,Other,4.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.23,4.23, NF-VALACYCLOVIR HCL ORAL TABLET 500MG,250,RC,,,,1,ME,both,28.9,20.23,,,,,,,,,,,,,,,,,,,Other,6.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.23,6.23, NF-XARELTO ORAL TABLET 15MG,250,RC,,,,1,ME,both,86.79,60.75,,,,,,,,,,,,,,,,,,,Other,18.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.71,18.71, NF-BREO ELLIPTA INH PWD 100MCG-25MCG/1AC,250,RC,,,,1,EA,both,31.63,22.14,,,,,,,,,,,,,,,,,,,Other,6.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.82,6.82, NF-ARAVA ORAL TABLET 20MG,250,RC,,,,1,ME,both,72.18,50.53,,,,,,,,,,,,,,,,,,,Other,15.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.56,15.56, NF-PANTOPRAZOLE SODIUM ORAL TAB DR 20MG,250,RC,,,,1,ME,both,21.07,14.75,,,,,,,,,,,,,,,,,,,Other,4.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.55,4.55, NF-ESTRADIOL TD PATCH ER 0.075MG/24HR,250,RC,,,,1,ME,both,72.9,51.03,,,,,,,,,,,,,,,,,,,Other,15.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.72,15.72, NF-CO-Q10 TABLET 60MG,250,RC,,,,1,ME,both,1.33,0.93,,,,,,,,,,,,,,,,,,,Other,0.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.28,0.28, NF-CO-Q10 ORAL CAPSULE 100MG,250,RC,,,,1,ME,both,1.47,1.03,,,,,,,,,,,,,,,,,,,Other,0.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.31,0.31, NF-PRALUENT SUBQ SOLN 75MG/1ML,250,RC,,,,1,ME,both,2688,1881.6,,,,,,,,,,,,,,,,,,,Other,579.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,579.53,579.53, NF-TRADJENTA ORAL TABLET 5MG,250,RC,,,,1,ME,both,84.01,58.81,,,,,,,,,,,,,,,,,,,Other,18.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.11,18.11, NF-METHOCARBAMOL 1000MG TAB,250,RC,,,,1,ME,both,112.88,79.02,,,,,,,,,,,,,,,,,,,Other,24.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.33,24.33, NF-OXYCODONE HCL CAP 5MG,250,RC,,,,1,ME,both,7.4,5.18,,,,,,,,,,,,,,,,,,,Other,1.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.6,1.6, NF-EZETIMIBE ORAL TABLET 10MG,250,RC,,,,1,ME,both,41.12,28.78,,,,,,,,,,,,,,,,,,,Other,8.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.87,8.87, NF-PRESERVISION ORAL LIQUID CAPSULE,250,RC,,,,1,EA,both,1.06,0.74,,,,,,,,,,,,,,,,,,,Other,0.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.23,0.23, NF-ROSUVASTATIN CALCIUM CAP 5MG,250,RC,,,,1,ME,both,15.87,11.11,,,,,,,,,,,,,,,,,,,Other,3.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.42,3.42, NF-ROSUVASTATIN CALCIUM ORAL TABLET 5MG,250,RC,,,,1,ME,both,28.58,20.01,,,,,,,,,,,,,,,,,,,Other,6.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.16,6.16, NF-BRIMONIDINE TARTRATE OPHTH SOLN 0.15%,250,RC,,,,1,EA,both,119.26,83.48,,,,,,,,,,,,,,,,,,,Other,25.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,25.72,25.72, NF-CREON CAP DR 36000U-114000U-180000U,250,RC,,,,1,UN,both,57.14,40,,,,,,,,,,,,,,,,,,,Other,12.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.32,12.32, NF-PREGABALIN CAP 200MG,250,RC,,,,1,ME,both,27.6,19.32,,,,,,,,,,,,,,,,,,,Other,5.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.95,5.95, NF-PREGABALIN CAP 225MG,250,RC,,,,1,ME,both,23.41,16.39,,,,,,,,,,,,,,,,,,,Other,5.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.05,5.05, NF-ASHLYNA TAB 30MCG-0.15MG;0.01MG,250,RC,,,,1,ME,both,13.4,9.38,,,,,,,,,,,,,,,,,,,Other,2.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.89,2.89, NF-GEMTESA ORAL TABLET 75MG,250,RC,,,,1,ME,both,75.54,52.88,,,,,,,,,,,,,,,,,,,Other,16.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.29,16.29, NF-BRIMONIDINE TARTRATE OPHTH SOLN 0.15%,250,RC,,,,1,ML,both,198.95,139.27,,,,,,,,,,,,,,,,,,,Other,42.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.89,42.89, NF-TELMISARTAN ORAL TABLET 20MG,250,RC,,,,1,ME,both,22.06,15.44,,,,,,,,,,,,,,,,,,,Other,4.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.75,4.75, NF-PRAZOSIN HCL CAP 2MG,250,RC,,,,1,ME,both,5.09,3.56,,,,,,,,,,,,,,,,,,,Other,1.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.1,1.1, NF-CHANTIX TAB 1MG,250,RC,,,,1,ME,both,40.23,28.16,,,,,,,,,,,,,,,,,,,Other,8.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.67,8.67, NF-ALTACE CAP 10MG,250,RC,,,,1,ME,both,4.82,3.37,,,,,,,,,,,,,,,,,,,Other,1.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.04,1.04, NF-ALTACE CAP 10MG,250,RC,,,,1,ME,both,4.82,3.37,,,,,,,,,,,,,,,,,,,Other,1.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.04,1.04, NF-TRELEGY ELLIPTA 100/62.5/25MCG/INH,250,RC,,,,1,EA,both,51.08,35.76,,,,,,,,,,,,,,,,,,,Other,11.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.02,11.02, NF-PRENATAL COMPLETE MULTIVITAMIN LIQ CA,250,RC,,,,1,EA,both,1.47,1.03,,,,,,,,,,,,,,,,,,,Other,0.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.31,0.31, NF-COLACE ORAL TABLET 50MG-8.6MG,250,RC,,,,1,ME,both,1.37,0.96,,,,,,,,,,,,,,,,,,,Other,0.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.29,0.29, NF-SIMVASTATIN ORAL TABLET 20MG,250,RC,,,,1,ME,both,19.57,13.7,,,,,,,,,,,,,,,,,,,Other,4.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.22,4.22, NF-LUMIGAN OPHTH SOLN 0.01%,250,RC,,,,1,ML,both,459.5,321.65,,,,,,,,,,,,,,,,,,,Other,99.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,99.07,99.07, NF-DORZOLAMIDE HCL OPHTHALMIC SOLUTION 2,250,RC,,,,1,ML,both,26.72,18.7,,,,,,,,,,,,,,,,,,,Other,5.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.76,5.76, LINACLOTIDE 72MCG CAPSULE (LINZESS),250,RC,,,,1,ME,both,93.04,65.13,,,,,,,,,,,,,,,,,,,Other,20.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.06,20.06, NF-ARMODAFINIL ORAL TABLET 250MG,250,RC,,,,1,ME,both,87.45,61.22,,,,,,,,,,,,,,,,,,,Other,18.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.86,18.86, NF-DESVENLAFAXINE ORAL TAB ER 100MG,250,RC,,,,1,ME,both,45.87,32.11,,,,,,,,,,,,,,,,,,,Other,9.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.89,9.89, NF-DILTIAZEM HCL 24 HR CAP ER 360MG,250,RC,,,,1,ME,both,10.36,7.25,,,,,,,,,,,,,,,,,,,Other,2.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.23,2.23, NF-TOPROL XL TAB ER 25MG,250,RC,,,,1,ME,both,5.74,4.02,,,,,,,,,,,,,,,,,,,Other,1.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.23,1.23, NF-ENTRESTO ORAL TABLET 97MG-103MG,250,RC,,,,1,ME,both,37,25.9,,,,,,,,,,,,,,,,,,,Other,7.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.98,7.98, NF-CARVEDILOL ORAL CAPSULE ER 10MG,250,RC,,,,1,ME,both,41.29,28.9,,,,,,,,,,,,,,,,,,,Other,8.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.9,8.9, NF-RESTASIS MULTIDOSE OPHTH EMUL 0.05%,250,RC,,,,1,ML,both,372.42,260.69,,,,,,,,,,,,,,,,,,,Other,80.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,80.29,80.29, NF-SIMVASTATIN ORAL TABLET 40MG,250,RC,,,,1,ME,both,19.57,13.7,,,,,,,,,,,,,,,,,,,Other,4.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.22,4.22, NF-WELLBUTRIN XL 24 HR TAB ER 150MG,250,RC,,,,1,ME,both,13.73,9.61,,,,,,,,,,,,,,,,,,,Other,2.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.96,2.96, NF-ROSUVASTATIN CALCIUM ORAL TABLET 20MG,250,RC,,,,1,ME,both,71.6,50.12,,,,,,,,,,,,,,,,,,,Other,15.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.44,15.44, NF-PRAVASTATIN SODIUM ORAL TABLET 10MG,250,RC,,,,1,ME,both,7.77,5.44,,,,,,,,,,,,,,,,,,,Other,1.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.68,1.68, NF-PRISTIQ EXTENDED-RELEASE TABLET 100MG,250,RC,,,,1,ME,both,70.07,49.05,,,,,,,,,,,,,,,,,,,Other,15.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.11,15.11, "NF-COQ10 ORAL CAPSULE, LIQUID FILLED 100",250,RC,,,,1,EA,both,1.31,0.92,,,,,,,,,,,,,,,,,,,Other,0.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.28,0.28, NF-AZO YEAST PLUS ORAL TABLET,250,RC,,,,1,ME,both,0.8,0.56,,,,,,,,,,,,,,,,,,,Other,0.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.18,0.18, NF-guaiFENesin/DEXTROMETHORPHAN HBR TAB,250,RC,,,,1,ME,both,1.24,0.87,,,,,,,,,,,,,,,,,,,Other,0.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.26,0.26, NF-MUCINEX DM ORAL TAB ER 30MG-600MG,250,RC,,,,1,ME,both,4.2,2.94,,,,,,,,,,,,,,,,,,,Other,0.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.9,0.9, NF-PRAVASTATIN SODIUM ORAL TABLET 80MG,250,RC,,,,1,ME,both,19.18,13.43,,,,,,,,,,,,,,,,,,,Other,4.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.14,4.14, NF-CREON CAP DR 6000U-19000U-30000U,250,RC,,,,1,ME,both,9.5,6.65,,,,,,,,,,,,,,,,,,,Other,2.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.05,2.05, NF-LEVETIRACETAM ORAL TABLET 250MG,250,RC,,,,1,ME,both,11.5,8.05,,,,,,,,,,,,,,,,,,,Other,2.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.48,2.48, NF-VITAMIN B12 ORAL TABLET 500MCG,250,RC,,,,1,ME,both,0.78,0.55,,,,,,,,,,,,,,,,,,,Other,0.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.17,0.17, NF-TACROLIMUS CAP 1MG,250,RC,,,,1,ME,both,17.84,12.49,,,,,,,,,,,,,,,,,,,Other,3.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.84,3.84, NF-SOTALOL HCL TAB 80MG,250,RC,,,,1,ME,both,112.01,78.41,,,,,,,,,,,,,,,,,,,Other,24.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.15,24.15, NF-CREON ORAL DELAYED RELEASE CAPSULE,250,RC,,,,1,ME,both,9.5,6.65,,,,,,,,,,,,,,,,,,,Other,2.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.05,2.05, NF-COQ10 ORAL CAPSULE 100MG,250,RC,,,,1,ME,both,0.56,0.39,,,,,,,,,,,,,,,,,,,Other,0.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.12,0.12, NF-ARMOUR THYROID TABLET 60MG,250,RC,,,,1,ME,both,4.43,3.1,,,,,,,,,,,,,,,,,,,Other,0.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.95,0.95, NF-UBRELVY ORAL TABLET 50MG,250,RC,,,,1,ME,both,472.32,330.62,,,,,,,,,,,,,,,,,,,Other,101.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,101.83,101.83, NF-ALLEGRA ALLERGY ORAL TABLET 180MG,250,RC,,,,1,ME,both,4.04,2.83,,,,,,,,,,,,,,,,,,,Other,0.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.87,0.87, NF-SYSTANE BALANCE OPHTH SOLN 0.6%,250,RC,,,,1,ML,both,5.1,3.57,,,,,,,,,,,,,,,,,,,Other,1.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.1,1.1, NF-LENALIDOMIDE CAP 2.5MG,250,RC,,,,1,ME,both,3999.48,2799.64,,,,,,,,,,,,,,,,,,,Other,862.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,862.29,862.29, NF-ROSUVASTATIN CALCIUM ORAL TABLET 40MG,250,RC,,,,1,ME,both,35.78,25.05,,,,,,,,,,,,,,,,,,,Other,7.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.71,7.71, NF-HYZAAR ORAL TABLET 50MG-12.5MG,250,RC,,,,1,ME,both,22.63,15.84,,,,,,,,,,,,,,,,,,,Other,4.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.88,4.88, NF-AVAPRO ORAL TABLET 300MG,250,RC,,,,1,ME,both,17.74,12.42,,,,,,,,,,,,,,,,,,,Other,3.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.82,3.82, NF-FLECAINIDE ACETATE AVPAK TAB 50MG,250,RC,,,,1,ME,both,16.21,11.35,,,,,,,,,,,,,,,,,,,Other,3.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.5,3.5, NF-DROXIDOPA CAP 100MG,250,RC,,,,1,ME,both,188.34,131.84,,,,,,,,,,,,,,,,,,,Other,40.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,40.6,40.6, NF-MYLANTA MAXIMUM STRENGTH ORAL SUSPENS,250,RC,,,,1,ME,both,0.07,0.05,,,,,,,,,,,,,,,,,,,Other,0.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.02,0.02, NF-NORTHERA CAP 200MG,250,RC,,,,1,ME,both,376.68,263.68,,,,,,,,,,,,,,,,,,,Other,81.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,81.21,81.21, NF-PYRIDOSTIGMINE BROMIDE ORAL TABLET 30,250,RC,,,,1,ME,both,34.81,24.37,,,,,,,,,,,,,,,,,,,Other,7.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.51,7.51, NF-CARBIDOPA/LEVODOPA TABLET 25MG-100MG,250,RC,,,,1,ME,both,0.86,0.6,,,,,,,,,,,,,,,,,,,Other,0.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.19,0.19, NF-D-MANNOSE ORAL CAPSULE 300MG,250,RC,,,,1,ME,both,0.86,0.6,,,,,,,,,,,,,,,,,,,Other,0.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.19,0.19, NF-TAMBOCOR ORAL TABLET 50MG,250,RC,,,,1,ME,both,11.08,7.76,,,,,,,,,,,,,,,,,,,Other,2.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.39,2.39, NF-TRAVATAN Z OPHTH SOLN 0.004%,250,RC,,,,1,ML,both,175.33,122.73,,,,,,,,,,,,,,,,,,,Other,37.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.8,37.8, NF-COQ10 ORAL CAPSULE 100MG,250,RC,,,,1,ME,both,0.56,0.39,,,,,,,,,,,,,,,,,,,Other,0.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.12,0.12, NF-SYNTHROID ORAL TABLET 137MCG,250,RC,,,,1,ME,both,7.21,5.05,,,,,,,,,,,,,,,,,,,Other,1.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.56,1.56, NF-ALTAVERA ORAL TABLET 0.15MG-30MCG,250,RC,,,,1,ME,both,4.42,3.09,,,,,,,,,,,,,,,,,,,Other,0.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.95,0.95, NF-LIOTHYRONINE SODIUM ORAL TABLET 25MCG,250,RC,,,,1,ME,both,4.25,2.98,,,,,,,,,,,,,,,,,,,Other,0.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.92,0.92, NF-MAGNESIUM CITRATE ORAL CAPSULE 100MG,250,RC,,,,1,ME,both,1.12,0.78,,,,,,,,,,,,,,,,,,,Other,0.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.24,0.24, NF-BUTALBITAL COMPOUND W/CODEINE CAPSULE,250,RC,,,,1,ME,both,16.33,11.43,,,,,,,,,,,,,,,,,,,Other,3.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.52,3.52, NF-VALIUM ORAL TABLET 2MG,250,RC,,,,1,ME,both,23.4,16.38,,,,,,,,,,,,,,,,,,,Other,5.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.05,5.05, NF-BECONASE AQ SPRAY 0.042MG/ACT,250,RC,,,,1,ME,both,56.32,39.42,,,,,,,,,,,,,,,,,,,Other,12.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.14,12.14, NF-HALOG CRM 0.1%,250,RC,,,,1,EA,both,8.91,6.24,,,,,,,,,,,,,,,,,,,Other,1.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.92,1.92, NF-HAIR VITAMINS EXTRA STRENGTH TABLET,250,RC,,,,1,ME,both,0.56,0.39,,,,,,,,,,,,,,,,,,,Other,0.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.12,0.12, NF-ESTROVEN COMPLETE MENOPAUSE RELIEF,250,RC,,,,1,ME,both,2.36,1.65,,,,,,,,,,,,,,,,,,,Other,0.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.51,0.51, NF-AZELASTINE HCL NASAL SPRAY 137MCG/1AC,250,RC,,,,1,EA,both,14.03,9.82,,,,,,,,,,,,,,,,,,,Other,3.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.03,3.03, NF-metroNIDAZOLE BENZOATE PWD,250,RC,,,,1,ME,both,60,42,,,,,,,,,,,,,,,,,,,Other,12.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.94,12.94, NF-EMPAGLIFLOZIN TAB 25MG,250,RC,,,,1,ME,both,94.93,66.45,,,,,,,,,,,,,,,,,,,Other,20.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.46,20.46, NF-TAMOXIFEN CITRATE ORAL TABLET 20MG,250,RC,,,,1,ME,both,15.15,10.61,,,,,,,,,,,,,,,,,,,Other,3.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.26,3.26, NF-LEVOXYL ORAL TABLET 200MCG,250,RC,,,,1,ME,both,2.27,1.59,,,,,,,,,,,,,,,,,,,Other,0.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.49,0.49, NF-HUMALOG INJECTION SOLUTION 100U/ML,250,RC,,,,1,UN,both,131.85,92.3,,,,,,,,,,,,,,,,,,,Other,28.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,28.43,28.43, NF-FLUOXETINE HCL CAP 40MG,250,RC,,,,1,ME,both,22.14,15.5,,,,,,,,,,,,,,,,,,,Other,4.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.77,4.77, NF-CELEXA TAB 20MG,250,RC,,,,1,ME,both,29.48,20.64,,,,,,,,,,,,,,,,,,,Other,6.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.36,6.36, NF-ENTRESTO ORAL TABLET 97MG-103MG,250,RC,,,,1,ME,both,53.44,37.41,,,,,,,,,,,,,,,,,,,Other,11.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.52,11.52, NF-MIRABEGRON TAB ER 50MG,250,RC,,,,1,ME,both,71.5,50.05,,,,,,,,,,,,,,,,,,,Other,15.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.42,15.42, NF-UPNEEQ OPHTH SOLUTION 0.1%,250,RC,,,,1,ME,both,33.33,23.33,,,,,,,,,,,,,,,,,,,Other,7.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.18,7.18, NF-SYSTANE COMPLETE OPHTH SOLN 0.6%,250,RC,,,,1,ML,both,5.82,4.07,,,,,,,,,,,,,,,,,,,Other,1.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.25,1.25, NF-ARICEPT ORAL TABLET 23MG,250,RC,,,,1,ME,both,72.38,50.67,,,,,,,,,,,,,,,,,,,Other,15.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.6,15.6, NF-LENALIDOMIDE CAP 5MG,250,RC,,,,1,ME,both,3999.48,2799.64,,,,,,,,,,,,,,,,,,,Other,862.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,862.29,862.29, NF-LENALIDOMIDE CAP 5MG,250,RC,,,,1,ME,both,3999.48,2799.64,,,,,,,,,,,,,,,,,,,Other,862.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,862.29,862.29, NF-LACTAID ORAL TABLET 3000U,250,RC,,,,1,UN,both,0.49,0.34,,,,,,,,,,,,,,,,,,,Other,0.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.11,0.11, NF-OZEMPIC 1MG DOSES SUBQ SOLN 4MG/3ML,C9399,HCPCS,250,RC,,1,ME,both,1497.23,1048.06,,,,,,,,,,,,,,,,,,,Other,322.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,322.8,322.8, NF-NUPERCAINAL OINTMENT 1%,250,RC,,,,1,EA,both,0.96,0.67,,,,,,,,,,,,,,,,,,,Other,0.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.21,0.21, NF-MEDIHONEY TOPICAL GEL 100%,250,RC,,,,1,EA,both,3.85,2.7,,,,,,,,,,,,,,,,,,,Other,0.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.83,0.83, NF-MEDIHONEY TOPICAL GEL 100%,250,RC,,,,1,EA,both,3.85,2.7,,,,,,,,,,,,,,,,,,,Other,0.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.83,0.83, NF-AMERGE TAB 2.5MG,250,RC,,,,1,ME,both,271.57,190.1,,,,,,,,,,,,,,,,,,,Other,58.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,58.56,58.56, NF-PRESERVISION ORAL LIQUID CAPSULE,250,RC,,,,1,EA,both,1.06,0.74,,,,,,,,,,,,,,,,,,,Other,0.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.23,0.23, NF-PANTOPRAZOLE SODIUM AVPAK TAB DR 40MG,250,RC,,,,1,ME,both,16.11,11.28,,,,,,,,,,,,,,,,,,,Other,3.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.47,3.47, NF-ENTRESTO ORAL TABLET 49MG-51MG,250,RC,,,,1,ME,both,37,25.9,,,,,,,,,,,,,,,,,,,Other,7.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.98,7.98, NF-DEXTROSE 5%/LACTATED RINGERS INJECTIO,250,RC,,,,1,ML,both,0.01,0.01,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF-GLUCOSAMINE CHONDROITIN 1500/1200 CAP,250,RC,,,,1,ME,both,0.97,0.68,,,,,,,,,,,,,,,,,,,Other,0.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.21,0.21, NF-LEVOTHYROXINE ORAL TABLET 100MCG,250,RC,,,,1,ME,both,2.34,1.64,,,,,,,,,,,,,,,,,,,Other,0.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.5,0.5, NF-SYNTHROID ORAL TABLET 100MCG,250,RC,,,,1,ME,both,7.21,5.05,,,,,,,,,,,,,,,,,,,Other,1.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.56,1.56, NF-ATROVENT HFA SOLN INH ORAL NEB 0.017M,250,RC,,,,1,EA,both,50.13,35.09,,,,,,,,,,,,,,,,,,,Other,10.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.81,10.81, NF-IPRATROPIUM BROMIDE NASAL SPRAY 0.03%,250,RC,,,,1,EA,both,14.89,10.42,,,,,,,,,,,,,,,,,,,Other,3.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.21,3.21, NF-PRAVASTATIN ORAL TABLET 20MG,250,RC,,,,1,ME,both,13.07,9.15,,,,,,,,,,,,,,,,,,,Other,2.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.82,2.82, NF-MYRBETRIQ ORAL TABLET 50MG,250,RC,,,,1,ME,both,71.5,50.05,,,,,,,,,,,,,,,,,,,Other,15.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.42,15.42, NF-CREON CAP DR 24000U-76000U-120000U,250,RC,,,,1,UN,both,37.03,25.92,,,,,,,,,,,,,,,,,,,Other,7.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.99,7.99, NF-PREMARIN ORAL TABLET 0.3MG,250,RC,,,,1,ME,both,4.92,3.44,,,,,,,,,,,,,,,,,,,Other,1.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.06,1.06, NF-HUMIRA SUBCUTANEOUS KIT,250,RC,,,,1,EA,both,16614.28,11630,,,,,,,,,,,,,,,,,,,Other,3582.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3582.04,3582.04, NF-HUMIRA SUBQ KIT 40MG/0.8ML,250,RC,,,,1,ME,both,16614.28,11630,,,,,,,,,,,,,,,,,,,Other,3582.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3582.04,3582.04, NF-TRIAMTERENE AND HCTZ TABLET 37.5MG-25,250,RC,,,,1,EA,both,1.57,1.1,,,,,,,,,,,,,,,,,,,Other,0.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.34,0.34, NF-GLIMEPIRIDE ORAL TABLET 2MG,250,RC,,,,1,ME,both,2.53,1.77,,,,,,,,,,,,,,,,,,,Other,0.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.55,0.55, NF-DECADRON TAB 6MG,250,RC,,,,1,ME,both,28.55,19.99,,,,,,,,,,,,,,,,,,,Other,6.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.15,6.15, NF-LEVOTHYROXINE ORAL TABLET 50MCG,250,RC,,,,1,ME,both,1.98,1.39,,,,,,,,,,,,,,,,,,,Other,0.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.43,0.43, NF-SOTALOL HCL AF ORAL TABLET 120MG,250,RC,,,,1,ME,both,1.25,0.88,,,,,,,,,,,,,,,,,,,Other,0.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.27,0.27, NF-TRELEGY ELLIPTA 100/62.5/25MCG/INH,250,RC,,,,1,EA,both,51.01,35.71,,,,,,,,,,,,,,,,,,,Other,11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11,11, NF-ACIDOPHILUS ORAL CAPSULE,250,RC,,,,1,ME,both,0.12,0.08,,,,,,,,,,,,,,,,,,,Other,0.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.03,0.03, NF-THERA-M MULTIPLE TABLET,250,RC,,,,1,ME,both,0.12,0.08,,,,,,,,,,,,,,,,,,,Other,0.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.03,0.03, NF-MUCUS RELIEF D TAB ER 600MG-60MG,250,RC,,,,1,ME,both,2.75,1.93,,,,,,,,,,,,,,,,,,,Other,0.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.6,0.6, NF-ICY HOT CREAM,250,RC,,,,1,EA,both,0.52,0.36,,,,,,,,,,,,,,,,,,,Other,0.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.11,0.11, NF-OLMESARTAN MEDOXOMIL-HYDROCHLOROTHIAZ,250,RC,,,,1,ME,both,38.43,26.9,,,,,,,,,,,,,,,,,,,Other,8.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.28,8.28, NF-VERAPAMIL HCL CAPSULE 120MG,250,RC,,,,1,ME,both,7.76,5.43,,,,,,,,,,,,,,,,,,,Other,1.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.68,1.68, NF-B12 ORAL SOLUTION 1000MCG/15ML,250,RC,,,,1,ME,both,0.15,0.11,,,,,,,,,,,,,,,,,,,Other,0.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.03,0.03, NF-DOPTELET ORAL TAB 20MG,250,RC,,,,1,ME,both,1975.73,1383.01,,,,,,,,,,,,,,,,,,,Other,425.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,425.97,425.97, NF-KRAZATI ORAL TABLET 200MG,250,RC,,,,1,ME,both,557.74,390.42,,,,,,,,,,,,,,,,,,,Other,120.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,120.25,120.25, NF-ZEGERID CAP 20MG-1100MG,250,RC,,,,1,ME,both,529.09,370.36,,,,,,,,,,,,,,,,,,,Other,114.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,114.07,114.07, NF-RYBELSUS ORAL TABLET 7MG,250,RC,,,,1,ME,both,154.96,108.47,,,,,,,,,,,,,,,,,,,Other,33.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,33.41,33.41, NF-ENTRESTO ORAL TABLET 49MG-51MG,250,RC,,,,1,ME,both,53.44,37.41,,,,,,,,,,,,,,,,,,,Other,11.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.52,11.52, NF-FIORICET ORAL CAPSULE 300MG-50MG-40MG,250,RC,,,,1,ME,both,36.94,25.86,,,,,,,,,,,,,,,,,,,Other,7.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.97,7.97, NF-CONSTULOSE ORAL SOLN 10GM/15ML,250,RC,,,,1,ME,both,0.34,0.24,,,,,,,,,,,,,,,,,,,Other,0.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.07,0.07, NF-CITALOPRAM HYDROBROMIDE ORAL TABLET 4,250,RC,,,,1,EA,both,10.74,7.52,,,,,,,,,,,,,,,,,,,Other,2.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.31,2.31, NF-BILBERRY EXTRACT CAPSULE,250,RC,,,,1,ME,both,0.54,0.38,,,,,,,,,,,,,,,,,,,Other,0.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.12,0.12, NF-VITAMIN D3 DIS TAB 125MCG,250,RC,,,,1,ME,both,0.61,0.43,,,,,,,,,,,,,,,,,,,Other,0.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.13,0.13, NF-FLUTICASONE PROPIONATE 0.05MG/1ACT,250,RC,,,,1,EA,both,21.31,14.92,,,,,,,,,,,,,,,,,,,Other,4.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.6,4.6, NF-ZINC BALANCE CAPSULE,250,RC,,,,1,ME,both,0.53,0.37,,,,,,,,,,,,,,,,,,,Other,0.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.12,0.12, NF-FENOFIBRATE CAP 50MG,250,RC,,,,1,ME,both,17.41,12.19,,,,,,,,,,,,,,,,,,,Other,3.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.75,3.75, NF-MODAFINIL ORAL TABLET 100MG,250,RC,,,,1,ME,both,105.51,73.86,,,,,,,,,,,,,,,,,,,Other,22.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.75,22.75, NF-TRAMADOL/APAP ORAL TABLET 37.5MG-325M,250,RC,,,,1,ME,both,8.58,6.01,,,,,,,,,,,,,,,,,,,Other,1.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.85,1.85, NF-ALTAVERA ORAL TABLET 0.15MG-30MCG,250,RC,,,,1,ME,both,4.42,3.09,,,,,,,,,,,,,,,,,,,Other,0.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.95,0.95, NF-ALLEGRA ALLERGY ORAL TABLET 180MG,250,RC,,,,1,ME,both,0.88,0.62,,,,,,,,,,,,,,,,,,,Other,0.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.19,0.19, NF-LISINOPRIL/HCTZ 20MG-12.5MG,250,RC,,,,1,ME,both,4.85,3.4,,,,,,,,,,,,,,,,,,,Other,1.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.05,1.05, NF-POTASSIUM CHLORIDE CAP ER 8MEQ,250,RC,,,,1,ME,both,3.76,2.63,,,,,,,,,,,,,,,,,,,Other,0.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.81,0.81, NF-AUGMENTIN ES-600 PWD FOR SUSP 600MG/5,250,RC,,,,1,ME,both,3.39,2.37,,,,,,,,,,,,,,,,,,,Other,0.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.74,0.74, NF-AMOXICILLIN & CLAVULANATE 600-42.9/5,250,RC,,,,1,ME,both,0.67,0.47,,,,,,,,,,,,,,,,,,,Other,0.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.15,0.15, NF-VENLAFAXINE HCL CAP ER 150MG,250,RC,,,,1,ME,both,73.58,51.51,,,,,,,,,,,,,,,,,,,Other,15.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.87,15.87, NF-CALCIUM ACETATE CAP 667MG,250,RC,,,,1,ME,both,2.87,2.01,,,,,,,,,,,,,,,,,,,Other,0.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.62,0.62, NF-PROTONIX ORAL GRANULES 40MG,250,RC,,,,1,ME,both,69.16,48.41,,,,,,,,,,,,,,,,,,,Other,14.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.92,14.92, NF-PROTONIX ORAL TAB DR 40MG,250,RC,,,,1,ME,both,25.44,17.81,,,,,,,,,,,,,,,,,,,Other,5.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.49,5.49, NF-ALTAVERA ORAL TABLET 0.15MG-30MCG,250,RC,,,,1,ME,both,4.42,3.09,,,,,,,,,,,,,,,,,,,Other,0.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.95,0.95, NF-CILOSTAZOL AVPAK TAB 50MG,250,RC,,,,1,ME,both,8.93,6.25,,,,,,,,,,,,,,,,,,,Other,1.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.92,1.92, NF-WIXELA INHUB INHALATION DISK 500/50,250,RC,,,,1,EA,both,39.38,27.57,,,,,,,,,,,,,,,,,,,Other,8.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.49,8.49, NF-DONEPEZIL HCL ORAL TABLET 23MG,250,RC,,,,1,ME,both,45.43,31.8,,,,,,,,,,,,,,,,,,,Other,9.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.79,9.79, NF-PROTONIX ORAL TAB DR 40MG,250,RC,,,,1,ME,both,69.48,48.64,,,,,,,,,,,,,,,,,,,Other,14.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.98,14.98, NF-LOVASTATIN ORAL TABLET 20MG,250,RC,,,,1,ME,both,9.49,6.64,,,,,,,,,,,,,,,,,,,Other,2.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.05,2.05, NF-LORAZEPAM ORAL TABLET 0.5MG,250,RC,,,,1,ME,both,2.71,1.9,,,,,,,,,,,,,,,,,,,Other,0.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.59,0.59, NF-MINOCYCLINE HCL CAP 50MG,250,RC,,,,1,ME,both,6.57,4.6,,,,,,,,,,,,,,,,,,,Other,1.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.42,1.42, NF-TOLTERODINE TARTRATE CAP ER 2MG,250,RC,,,,1,ME,both,52.05,36.44,,,,,,,,,,,,,,,,,,,Other,11.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.22,11.22, NF-PRISTIQ EXTENDED-RELEASE TABLET 50MG,250,RC,,,,1,ME,both,70.07,49.05,,,,,,,,,,,,,,,,,,,Other,15.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.11,15.11, NF-DAPSONE ORAL TABLET 25MG,250,RC,,,,1,ME,both,10.95,7.67,,,,,,,,,,,,,,,,,,,Other,2.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.36,2.36, NF-CABOZANTINIB MALATE TAB 20MG,250,RC,,,,1,ME,both,4093.57,2865.5,,,,,,,,,,,,,,,,,,,Other,882.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,882.58,882.58, DENOSUMAB 60MG/1ML SQ INJ (PROLIA),J0897,HCPCS,636,RC,,1,ME,both,9677.24,6774.07,,,,,,,,,,,,,,,,,,,Other,2086.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,28.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,28.87,2086.41, NF-PRAVASTATIN SODIUM ORAL TABLET 80MG,250,RC,,,,1,ME,both,19.18,13.43,,,,,,,,,,,,,,,,,,,Other,4.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.14,4.14, NF-DUTASTERIDE LIQ CAP 0.5MG,250,RC,,,,1,ME,both,19.34,13.54,,,,,,,,,,,,,,,,,,,Other,4.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.16,4.16, NF-PRAVACHOL ORAL TABLET 40MG,250,RC,,,,1,ME,both,26.91,18.84,,,,,,,,,,,,,,,,,,,Other,5.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.8,5.8, NF-BRILINTA ORAL TABLET 90MG,250,RC,,,,1,ME,both,36.1,25.27,,,,,,,,,,,,,,,,,,,Other,7.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.78,7.78, NF-AMLODIPINE & BENAZEPRIL HCL 10MG-40MG,250,RC,,,,1,ME,both,21.52,15.06,,,,,,,,,,,,,,,,,,,Other,4.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.64,4.64, NF-ESOMEPRAZOLE MAG CAP DR 20MG,250,RC,,,,1,ME,both,35.33,24.73,,,,,,,,,,,,,,,,,,,Other,7.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.61,7.61, NF-ESOMEPRAZOLE MAGNESIUM CAP DR 20MG,250,RC,,,,1,ME,both,2.89,2.02,,,,,,,,,,,,,,,,,,,Other,0.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.63,0.63, NF-NORTRIPTYLINE HCL CAP 50MG,250,RC,,,,1,ME,both,14.8,10.36,,,,,,,,,,,,,,,,,,,Other,3.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.19,3.19, NF-ESOMEPRAZOLE MAGNESIUM CAP DR 20MG,250,RC,,,,1,ME,both,35.47,24.83,,,,,,,,,,,,,,,,,,,Other,7.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.64,7.64, NF-TYLENOL ARTHRITIS ORAL TABLET 650MG,250,RC,,,,1,ME,both,0.63,0.44,,,,,,,,,,,,,,,,,,,Other,0.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.14,0.14, NF-DILTIAZEM HCL CAPSULE 60MG,250,RC,,,,1,ME,both,12.69,8.88,,,,,,,,,,,,,,,,,,,Other,2.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.73,2.73, NF-FENOFIBRATE MICRO ORAL CAPSULE 134MG,250,RC,,,,1,ME,both,17.24,12.07,,,,,,,,,,,,,,,,,,,Other,3.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.71,3.71, NF-ARGINAID ORAL PWD FOR SUSP 4.5GM/9.2G,250,RC,,,,1,GM,both,5.52,3.86,,,,,,,,,,,,,,,,,,,Other,1.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.19,1.19, NF-ADDERALL XR CAP ER 30MG,250,RC,,,,1,ME,both,35.02,24.51,,,,,,,,,,,,,,,,,,,Other,7.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.55,7.55, NF-CELEXA TABLET 20MG,250,RC,,,,1,ME,both,17.12,11.98,,,,,,,,,,,,,,,,,,,Other,3.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.69,3.69, NF-NIACIN CAP ER 500MG,250,RC,,,,1,ME,both,0.53,0.37,,,,,,,,,,,,,,,,,,,Other,0.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.12,0.12, NF-PRAVACHOL ORAL TABLET 40MG,250,RC,,,,1,ME,both,26.91,18.84,,,,,,,,,,,,,,,,,,,Other,5.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.8,5.8, NF-PRAVACHOL ORAL TABLET 20MG,250,RC,,,,1,ME,both,18.4,12.88,,,,,,,,,,,,,,,,,,,Other,3.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.97,3.97, NF-MAGNESIUM ALUMINUM SILICATE POWDER,250,RC,,,,1,ME,both,0.22,0.15,,,,,,,,,,,,,,,,,,,Other,0.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.05,0.05, NF-BREO ELLIPTA INH PWD 100MCG-25MCG/1AC,250,RC,,,,1,EA,both,32.58,22.81,,,,,,,,,,,,,,,,,,,Other,7.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.03,7.03, NF-DILANTIN EXTENDED RELEASE CAPSULE 100,250,RC,,,,1,ME,both,1.72,1.2,,,,,,,,,,,,,,,,,,,Other,0.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.37,0.37, NF-REFRESH EYE ITCH RELIEF SOLUTION 0.0,250,RC,,,,1,ME,both,8.82,6.17,,,,,,,,,,,,,,,,,,,Other,1.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.9,1.9, NF-MODAFINIL ORAL TABLET 100MG,250,RC,,,,1,ME,both,105.51,73.86,,,,,,,,,,,,,,,,,,,Other,22.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.75,22.75, NF-PHOSPHO-TRIN 250 NEUTRAL TAB 852MG-15,250,RC,,,,1,ME,both,1.96,1.37,,,,,,,,,,,,,,,,,,,Other,0.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.42,0.42, NF-SIMETHICONE ORAL SUSPENSION 40MG/0.6M,250,RC,,,,1,ME,both,2.06,1.44,,,,,,,,,,,,,,,,,,,Other,0.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.44,0.44, NF-LEVOTHYROXINE ORAL TABLET 100MCG,250,RC,,,,1,ME,both,2.2,1.54,,,,,,,,,,,,,,,,,,,Other,0.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.47,0.47, NF-LEVOBUNOLOL HCL OPHTH SOLN 0.25%,250,RC,,,,1,ME,both,19.66,13.76,,,,,,,,,,,,,,,,,,,Other,4.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.24,4.24, NF-SYNTHROID ORAL TABLET 88MCG,250,RC,,,,1,ME,both,2.62,1.83,,,,,,,,,,,,,,,,,,,Other,0.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.57,0.57, NF-LANOXIN ORAL TABLET 0.0625MG,250,RC,,,,1,ME,both,50.11,35.08,,,,,,,,,,,,,,,,,,,Other,10.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.8,10.8, NF-EUTHYROX ORAL TABLET 75MCG,250,RC,,,,1,ME,both,0.83,0.58,,,,,,,,,,,,,,,,,,,Other,0.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.18,0.18, NF-MOUNJARO SUBQ SOLN 5MG/0.5ML,250,RC,,,,1,ME,both,2565.8,1796.06,,,,,,,,,,,,,,,,,,,Other,553.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,553.19,553.19, NF-NOVOLIN N (NPH) SUBQ SUSP 100U/1ML,250,RC,,,,1,ML,both,6.38,4.47,,,,,,,,,,,,,,,,,,,Other,1.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.37,1.37, NF-NOVOLIN N (NPH) SUBQ SUSP 100U/1ML,250,RC,,,,1,ML,both,6.38,4.47,,,,,,,,,,,,,,,,,,,Other,1.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.37,1.37, NF-LEVSIN ORAL TABLET 0.125MG,250,RC,,,,1,ME,both,3.62,2.53,,,,,,,,,,,,,,,,,,,Other,0.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.78,0.78, NF-DESVENLAFAXINE ORAL TABLET ER 50MG,250,RC,,,,1,ME,both,23.22,16.25,,,,,,,,,,,,,,,,,,,Other,5.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.01,5.01, NF-AMLODIPINE-VALSARTAN ORAL TABLET,250,RC,,,,1,EA,both,21.86,15.3,,,,,,,,,,,,,,,,,,,Other,4.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.71,4.71, NF-CIALIS TAB 5MG,250,RC,,,,1,ME,both,46.12,32.28,,,,,,,,,,,,,,,,,,,Other,9.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.95,9.95, NF-MOMETASONE FUROATE CRM 0.1%,250,RC,,,,1,EA,both,4.7,3.29,,,,,,,,,,,,,,,,,,,Other,1.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.01,1.01, NF-ENEMA RECTAL LIQUID,250,RC,,,,1,EA,both,0.02,0.01,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, NF- LEADER BURN RELIEF SPRAY 0.5%,250,RC,,,,1,EA,both,0.17,0.12,,,,,,,,,,,,,,,,,,,Other,0.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.04,0.04, NF-MAGNESIUM GLUCONATE TABLET 500MG,250,RC,,,,1,ME,both,0.53,0.37,,,,,,,,,,,,,,,,,,,Other,0.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.12,0.12, NF-MAGNESIUM GLYCINATE POWDER,250,RC,,,,1,ME,both,2.88,2.02,,,,,,,,,,,,,,,,,,,Other,0.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.62,0.62, NF-ENTRESTO ORAL TABLET 24MG-26MG,250,RC,,,,1,ME,both,55.04,38.53,,,,,,,,,,,,,,,,,,,Other,11.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.87,11.87, NF-ENTRESTO ORAL TABLET 24MG-26MG,250,RC,,,,1,ME,both,55.04,38.53,,,,,,,,,,,,,,,,,,,Other,11.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.87,11.87, NF-LISINOPRIL ORAL TABLET 30MG,250,RC,,,,1,ME,both,5.96,4.17,,,,,,,,,,,,,,,,,,,Other,1.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.28,1.28, NF-CELEXA TABLET 40MG,250,RC,,,,1,ME,both,18.73,13.11,,,,,,,,,,,,,,,,,,,Other,4.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.04,4.04, NF-CITALOPRAM HYDROBROMIDE ORAL TABLET 2,250,RC,,,,1,ME,both,1.11,0.78,,,,,,,,,,,,,,,,,,,Other,0.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.24,0.24, NF-CREON CAP DR 24000U-76000U-120000U,250,RC,,,,1,UN,both,39.52,27.66,,,,,,,,,,,,,,,,,,,Other,8.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.52,8.52, NF-THERATEARS OPHTH SOLUTION 0.25%,250,RC,,,,1,EA,both,3.73,2.61,,,,,,,,,,,,,,,,,,,Other,0.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.8,0.8, NF-PAXIL CR TAB ER 25MG,250,RC,,,,1,ME,both,17.57,12.3,,,,,,,,,,,,,,,,,,,Other,3.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.79,3.79, NF-PAXIL CR TABLET 12.5MG,250,RC,,,,1,ME,both,16.3,11.41,,,,,,,,,,,,,,,,,,,Other,3.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.52,3.52, NF-PAXIL CR TABLET 25MG,250,RC,,,,1,ME,both,17.57,12.3,,,,,,,,,,,,,,,,,,,Other,3.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.79,3.79, NF-PRISTIQ ORAL TABLET ER 25MG,250,RC,,,,1,ME,both,70.07,49.05,,,,,,,,,,,,,,,,,,,Other,15.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.11,15.11, NF-CILOSTAZOL ORAL TABLET 50MG,250,RC,,,,1,ME,both,7.3,5.11,,,,,,,,,,,,,,,,,,,Other,1.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.58,1.58, NF-ATROVENT HFA SOLN INH ORAL NEB 0.017M,250,RC,,,,1,ML,both,50.13,35.09,,,,,,,,,,,,,,,,,,,Other,10.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.81,10.81, NF-DABIGATRAN ETEXILATE MESYLATE CAP 150,250,RC,,,,1,ME,both,32.05,22.44,,,,,,,,,,,,,,,,,,,Other,6.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.91,6.91, NF-CRESTOR TAB 10MG,250,RC,,,,1,ME,both,22.46,15.72,,,,,,,,,,,,,,,,,,,Other,4.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.84,4.84, NF-KEPPRA ORAL TABLET 250MG,250,RC,,,,1,ME,both,9.17,6.42,,,,,,,,,,,,,,,,,,,Other,1.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.98,1.98, NF-CRESTOR TAB 20MG,250,RC,,,,1,ME,both,22.46,15.72,,,,,,,,,,,,,,,,,,,Other,4.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.84,4.84, NF-NIACIN ORAL TABLET 50MG,250,RC,,,,1,ME,both,0.11,0.08,,,,,,,,,,,,,,,,,,,Other,0.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.02,0.02, NF-SIMVASTATIN ORAL TABLET 20MG,250,RC,,,,1,ME,both,19.61,13.73,,,,,,,,,,,,,,,,,,,Other,4.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.22,4.22, NF-FLOMAX CAP 0.4MG,250,RC,,,,1,ME,both,103.92,72.74,,,,,,,,,,,,,,,,,,,Other,22.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.4,22.4, "NF-SIMETHICONE CAPSULE, LIQUID FILLED 12",250,RC,,,,1,ME,both,0.58,0.41,,,,,,,,,,,,,,,,,,,Other,0.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.13,0.13, NF-SIMVASTATIN ORAL TABLET 10MG,250,RC,,,,1,ME,both,11.22,7.85,,,,,,,,,,,,,,,,,,,Other,2.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.42,2.42, NF-HYDROXYZINE HCL ORAL TAB 10MG,250,RC,,,,1,ME,both,4.92,3.44,,,,,,,,,,,,,,,,,,,Other,1.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.06,1.06, NF-METOPROLOL ORAL TABLET 25MG,250,RC,,,,1,ME,both,1.15,0.81,,,,,,,,,,,,,,,,,,,Other,0.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.24,0.24, NF-OCUVITE TABLET,250,RC,,,,1,ME,both,0.58,0.41,,,,,,,,,,,,,,,,,,,Other,0.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.13,0.13, NF-MOMETASONE FUROATE CRM 0.1%,250,RC,,,,1,EA,both,4.7,3.29,,,,,,,,,,,,,,,,,,,Other,1.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.01,1.01, NF-MYRBETRIQ TAB ER 50MG,250,RC,,,,1,ME,both,73.65,51.56,,,,,,,,,,,,,,,,,,,Other,15.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.88,15.88, NF-SYNTHROID ORAL TABLET 300MCG,250,RC,,,,1,ME,both,3.96,2.77,,,,,,,,,,,,,,,,,,,Other,0.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.85,0.85, NF-valsartan Oral Tablet 80MG,250,RC,,,,1,ME,both,19,13.3,,,,,,,,,,,,,,,,,,,Other,4.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.1,4.1, NF-ADDERALL XR CAP ER 20MG,250,RC,,,,1,ME,both,34.19,23.93,,,,,,,,,,,,,,,,,,,Other,7.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.37,7.37, NF-DRAMAMINE ORAL TABLET 50MG,250,RC,,,,1,ME,both,1.71,1.2,,,,,,,,,,,,,,,,,,,Other,0.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.37,0.37, NF-CO Q-10 ORAL CAPSULE 200MG,250,RC,,,,1,ME,both,0.8,0.56,,,,,,,,,,,,,,,,,,,Other,0.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.18,0.18, NF-Ramipril Oral Capsule 2.5MG,250,RC,,,,1,ME,both,7,4.9,,,,,,,,,,,,,,,,,,,Other,1.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.51,1.51, NF-Lisinopril-HCTZ Tablet 20MG-12.5MG,250,RC,,,,1,ME,both,4,2.8,,,,,,,,,,,,,,,,,,,Other,0.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.86,0.86, NF-Farxiga Oral Tablet 10MG,250,RC,,,,1,ME,both,49,34.3,,,,,,,,,,,,,,,,,,,Other,10.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.56,10.56, NF-TRIAMCINOLONE ACETONIDE,250,RC,,,,1,ME,both,64.47,45.13,,,,,,,,,,,,,,,,,,,Other,13.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.9,13.9, NF-Breo Ellipta Inh Pwd 100MCG/1Actuatio,250,RC,,,,1,EA,both,32,22.4,,,,,,,,,,,,,,,,,,,Other,6.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.9,6.9, NF-Nortriptyline Oral Capsule 10MG,250,RC,,,,1,ME,both,2,1.4,,,,,,,,,,,,,,,,,,,Other,0.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.43,0.43, NF-Citalopram Oral Tablet 40MG,250,RC,,,,1,ME,both,10,7,,,,,,,,,,,,,,,,,,,Other,2.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.16,2.16, NF-ADDERALL TAB 20MG,250,RC,,,,1,ME,both,51.47,36.03,,,,,,,,,,,,,,,,,,,Other,11.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.09,11.09, NF-CREON CAP DR 12000U-38000U-60000U,250,RC,,,,1,UN,both,19.94,13.96,,,,,,,,,,,,,,,,,,,Other,4.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.3,4.3, NF-ZYRTEC-D ORAL TAB ER 5MG-120MG,250,RC,,,,1,ME,both,4.54,3.18,,,,,,,,,,,,,,,,,,,Other,0.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.98,0.98, NF-busPIRone Hydrochloride Tablet 30MG,250,RC,,,,1,ME,both,14,9.8,,,,,,,,,,,,,,,,,,,Other,3.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.02,3.02, NF-busPIRone Hydrochloride Tablet 30MG,250,RC,,,,1,ME,both,14,9.8,,,,,,,,,,,,,,,,,,,Other,3.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.02,3.02, NF-DULoxetine HCl Cap DR 60MG,250,RC,,,,1,ME,both,31,21.7,,,,,,,,,,,,,,,,,,,Other,6.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.68,6.68, NF-TraZODone HCl Oral Tablet 50MG,250,RC,,,,1,ME,both,4,2.8,,,,,,,,,,,,,,,,,,,Other,0.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.86,0.86, NF-Topiramate Oral Tablet 200MG,250,RC,,,,1,ME,both,32,22.4,,,,,,,,,,,,,,,,,,,Other,6.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.9,6.9, NF-buPROPion HCl XL 24HR Tab ER 150MG,250,RC,,,,1,ME,both,19,13.3,,,,,,,,,,,,,,,,,,,Other,4.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.1,4.1, NF-buPROPion HCl Oral Tab ER 12HR 150MG,250,RC,,,,1,ME,both,7,4.9,,,,,,,,,,,,,,,,,,,Other,1.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.51,1.51, NF-Ativan Oral Tablet 1MG,250,RC,,,,1,ME,both,219,153.3,,,,,,,,,,,,,,,,,,,Other,47.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.22,47.22, BOTOX INJ 200 UNITS,J0585,HCPCS,636,RC,,1,ME,both,6666.72,4666.7,,,,,,,,,,,,,,,,,,,Other,1437.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.38,1437.35, NF-PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.5MG,250,RC,,,,1,ME,both,35.38,24.77,,,,,,,,,,,,,,,,,,,Other,7.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.62,7.62, NF-Nortriptyline Oral Capsule 50MG,250,RC,,,,1,ME,both,11,7.7,,,,,,,,,,,,,,,,,,,Other,2.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.37,2.37, NF-Memantine HCl Oral Capsule ER 28MG,250,RC,,,,1,ME,both,14,9.8,,,,,,,,,,,,,,,,,,,Other,3.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.02,3.02, NF-Levothyroxine Oral Tablet 150MCG,250,RC,,,,1,ME,both,2,1.4,,,,,,,,,,,,,,,,,,,Other,0.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.43,0.43, NF-GUAIFENESIN ER ORAL TAB ER 600MG,250,RC,,,,1,ME,both,4.22,2.95,,,,,,,,,,,,,,,,,,,Other,0.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.91,0.91, NF-Flecainide Acetate Tablet 100MG,250,RC,,,,1,ME,both,14,9.8,,,,,,,,,,,,,,,,,,,Other,3.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.02,3.02, NF-REPATHA SUBQ SOLN 140MG/1ML,250,RC,,,,1,ME,both,1347.56,943.29,,,,,,,,,,,,,,,,,,,Other,290.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,290.53,290.53, NF-ALENDRONATE SOD ORAL TABLET 10MG,250,RC,,,,1,ME,both,20.65,14.46,,,,,,,,,,,,,,,,,,,Other,4.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.45,4.45, NF-MULTIVITAMIN AND IRON CAP,250,RC,,,,1,ME,both,6.75,4.73,,,,,,,,,,,,,,,,,,,Other,1.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.46,1.46, NF-Adderall Oral Tablet 20MG,250,RC,,,,1,ME,both,51,35.7,,,,,,,,,,,,,,,,,,,Other,11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11,11, NF-TraZODone HCl Tablet 300MG,250,RC,,,,1,ME,both,21,14.7,,,,,,,,,,,,,,,,,,,Other,4.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.53,4.53, NF-Geodon Capsule 80MG,250,RC,,,,1,ME,both,112,78.4,,,,,,,,,,,,,,,,,,,Other,24.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.15,24.15, NF-Geodon Capsule 40MG,250,RC,,,,1,ME,both,92,64.4,,,,,,,,,,,,,,,,,,,Other,19.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.84,19.84, NF-Geodon Capsule 20MG,250,RC,,,,1,ME,both,92,64.4,,,,,,,,,,,,,,,,,,,Other,19.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.84,19.84, NF-Geodon Capsule 40MG,250,RC,,,,1,ME,both,92,64.4,,,,,,,,,,,,,,,,,,,Other,19.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.84,19.84, NF-Geodon Capsule 80MG,250,RC,,,,1,ME,both,112,78.4,,,,,,,,,,,,,,,,,,,Other,24.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.15,24.15, NF-TraZODone HCl Tablet 300MG,250,RC,,,,1,ME,both,21,14.7,,,,,,,,,,,,,,,,,,,Other,4.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.53,4.53, NF-Lovastatin Tablet 20MG,250,RC,,,,1,ME,both,9,6.3,,,,,,,,,,,,,,,,,,,Other,1.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.94,1.94, NF-Lovastatin Tablet 20MG,250,RC,,,,1,ME,both,9,6.3,,,,,,,,,,,,,,,,,,,Other,1.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.94,1.94, NF-Lovastatin Tablet 20MG,250,RC,,,,1,ME,both,9,6.3,,,,,,,,,,,,,,,,,,,Other,1.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.94,1.94, NF-Lovastatin Tablet 20MG,250,RC,,,,1,ME,both,9,6.3,,,,,,,,,,,,,,,,,,,Other,1.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.94,1.94, NF-Wellbutrin XL 24 Hr Tab ER 300MG,250,RC,,,,1,ME,both,421,294.7,,,,,,,,,,,,,,,,,,,Other,90.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,90.77,90.77, NF-Wellbutrin XL 24 Hr Tab ER 300MG,250,RC,,,,1,ME,both,421,294.7,,,,,,,,,,,,,,,,,,,Other,90.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,90.77,90.77, NF-HALOBETASOL PROPIONATE CREAM 0.05%,250,RC,,,,1,EA,both,12.22,8.55,,,,,,,,,,,,,,,,,,,Other,2.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.64,2.64, NF-Wellbutrin XL 24 Hr Tab ER 300MG,250,RC,,,,1,ME,both,463,324.1,,,,,,,,,,,,,,,,,,,Other,99.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,99.82,99.82, NF-Wellbutrin XL 24 Hr Tab ER 300MG,250,RC,,,,1,ME,both,463,324.1,,,,,,,,,,,,,,,,,,,Other,99.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,99.82,99.82, NF-Wellbutrin XL 24 Hr Tab ER 150MG,250,RC,,,,1,ME,both,351,245.7,,,,,,,,,,,,,,,,,,,Other,75.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,75.68,75.68, NF-CRESTOR ORAL TABLET 40MG,250,RC,,,,1,ME,both,23.67,16.57,,,,,,,,,,,,,,,,,,,Other,5.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.11,5.11, NF-Creon Oral Cap DR 24000U-76000U-12000,250,RC,,,,1,UN,both,40,28,,,,,,,,,,,,,,,,,,,Other,8.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.62,8.62, NF-Creon Oral Cap DR 24000U-76000U-12000,250,RC,,,,1,UN,both,40,28,,,,,,,,,,,,,,,,,,,Other,8.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.62,8.62, NF-DORZOLAMIDE HCL OPHTH SOLN 2%,250,RC,,,,1,EA,both,26.72,18.7,,,,,,,,,,,,,,,,,,,Other,5.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.76,5.76, NF-Adderall Oral Tablet 20MG,250,RC,,,,1,UN,both,56,39.2,,,,,,,,,,,,,,,,,,,Other,12.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.07,12.07, NF-Botox Intramuscular Pwd for Soln 100U,250,RC,,,,1,UN,both,1375,962.5,,,,,,,,,,,,,,,,,,,Other,296.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,296.45,296.45, NF-Botox Cosmetic Injection 100u,250,RC,,,,1,ME,both,3148,2203.6,,,,,,,,,,,,,,,,,,,Other,678.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,678.71,678.71, CLINIMIX E 5/20 2000 ML,258,RC,,,,1,ME,both,448.87,314.21,,,,,,,,,,,,,,,,,,,Other,96.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,96.78,96.78, NF-FOLIVANE-F ORAL CAPSULE,250,RC,,,,1,ME,both,1.89,1.32,,,,,,,,,,,,,,,,,,,Other,0.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.41,0.41, NF-predniSONE Tablet 1MG,250,RC,,,,1,ME,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-predniSONE Tablet 1MG,250,RC,,,,1,ME,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-Levothyroxine Sodium Oral Tablet 137M,250,RC,,,,1,ME,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-Levothyroxine Sodium Oral Tablet 137M,250,RC,,,,1,ME,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-Spironolactone Tablet 50MG,250,RC,,,,1,ME,both,3,2.1,,,,,,,,,,,,,,,,,,,Other,0.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.65,0.65, NF-ESZOPICLONE ORAL TABLET 3MG,250,RC,,,,1,ME,both,46.65,32.66,,,,,,,,,,,,,,,,,,,Other,10.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.05,10.05, NF-CLINDAMYCIN PALMITATE HCL PWD FOR SOL,250,RC,,,,1,ME,both,2.48,1.74,,,,,,,,,,,,,,,,,,,Other,0.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.54,0.54, NF-Citalopram Oral Tablet 40MG,250,RC,,,,1,ME,both,10,7,,,,,,,,,,,,,,,,,,,Other,2.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.16,2.16, NF-Miconazole 1 Kit 1200MG;2%,250,RC,,,,1,EA,both,52,36.4,,,,,,,,,,,,,,,,,,,Other,11.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.21,11.21, NF-Miconazole 1 Kit 1200MG;2%,250,RC,,,,1,EA,both,52,36.4,,,,,,,,,,,,,,,,,,,Other,11.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.21,11.21, NF-MAGNESIUM GLYCINATE ORAL CAP 100MG,250,RC,,,,1,ME,both,0.74,0.52,,,,,,,,,,,,,,,,,,,Other,0.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.16,0.16, NF-Creon Oral Delayed Release Capsule,250,RC,,,,1,EA,both,10,7,,,,,,,,,,,,,,,,,,,Other,2.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.16,2.16, CLINIMIX E 4.25/5 1000ML,B4189,HCPCS,250,RC,,1,ME,both,222.14,155.5,,,,,,,,,,,,,,,,,,,Other,47.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.89,47.89, NF-BUPROPION HCL 24 HR TAB ER 150MG,250,RC,,,,1,ME,both,20.86,14.6,,,,,,,,,,,,,,,,,,,Other,4.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.5,4.5, NF-NexIUM Oral Packet 40MG/1Pkt,250,RC,,,,1,ME,both,45,31.5,,,,,,,,,,,,,,,,,,,Other,9.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.7,9.7, NF-NexIUM Capsule 40MG,250,RC,,,,1,ME,both,44,30.8,,,,,,,,,,,,,,,,,,,Other,9.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.49,9.49, NF-Benazepril Oral Tablet 40MG,250,RC,,,,1,ME,both,6,4.2,,,,,,,,,,,,,,,,,,,Other,1.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.29,1.29, NF-Cinacalcet Hydrochloride Oral Tab 60M,250,RC,,,,1,ME,both,245,171.5,,,,,,,,,,,,,,,,,,,Other,52.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,52.82,52.82, NF-MYFORTIC TAB EC 360MG,250,RC,,,,1,ME,both,71.59,50.11,,,,,,,,,,,,,,,,,,,Other,15.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,15.44,15.44, NF-ENVARSUS XR TAB ER 0.75MG,250,RC,,,,1,ME,both,25.03,17.52,,,,,,,,,,,,,,,,,,,Other,5.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.4,5.4, NF-Eplerenone Oral Tablet 50MG,250,RC,,,,1,ME,both,17,11.9,,,,,,,,,,,,,,,,,,,Other,3.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.67,3.67, NF-hydrALAZINE HCl Tablet 10MG,250,RC,,,,1,ME,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-Eplerenone Oral Tablet 50MG,250,RC,,,,1,ME,both,17,11.9,,,,,,,,,,,,,,,,,,,Other,3.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.67,3.67, NF-COLESEVELAM HCL ORAL TABLET 625MG,250,RC,,,,1,ME,both,14.97,10.48,,,,,,,,,,,,,,,,,,,Other,3.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.22,3.22, NF-Entresto Oral Tablet 49MG-51MG,250,RC,,,,1,ME,both,56,39.2,,,,,,,,,,,,,,,,,,,Other,12.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.07,12.07, NF-MORPHINE SULFATE CAP ER 100MG,250,RC,,,,1,ME,both,74.73,52.31,,,,,,,,,,,,,,,,,,,Other,16.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.11,16.11, NF-fentaNYL TD PATCH ER 100MCG/1HR,250,RC,,,,1,ME,both,213.44,149.41,,,,,,,,,,,,,,,,,,,Other,46.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,46.02,46.02, NF-AMPHETAMINE & DEXTROAMPHETAMINE MIXTU,250,RC,,,,1,ME,both,1.09,0.76,,,,,,,,,,,,,,,,,,,Other,0.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.24,0.24, NF-Morphine Sulfate IR Oral Tablet 30MG,250,RC,,,,1,ME,both,3,2.1,,,,,,,,,,,,,,,,,,,Other,0.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.65,0.65, NF-Morphine Sulfate IR Oral Tablet 30MG,250,RC,,,,1,ME,both,3,2.1,,,,,,,,,,,,,,,,,,,Other,0.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.65,0.65, NF-CASPOFUNGIN ACETATE IV PWD FOR SOLN 5,250,RC,,,,1,EA,both,331.2,231.84,,,,,,,,,,,,,,,,,,,Other,71.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,71.4,71.4, NF-JOURNAVX ORAL TABLET 50MG,250,RC,,,,1,ME,both,74.4,52.08,,,,,,,,,,,,,,,,,,,Other,16.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.04,16.04, NF-Adderall Oral Tablet 15MG,250,RC,,,,1,ME,both,56,39.2,,,,,,,,,,,,,,,,,,,Other,12.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.07,12.07, NF-Morphine Sulfate Tablet 15MG,250,RC,,,,1,ME,both,2,1.4,,,,,,,,,,,,,,,,,,,Other,0.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.43,0.43, NF-Morphine Sulfate Tablet 15MG,250,RC,,,,1,ME,both,2,1.4,,,,,,,,,,,,,,,,,,,Other,0.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.43,0.43, NF-KADIAN CAP ER 50MG,250,RC,,,,1,ME,both,45.56,31.89,,,,,,,,,,,,,,,,,,,Other,9.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.82,9.82, NF-Morphine Sulfate Oral Capsule ER 60MG,250,RC,,,,1,ME,both,45,31.5,,,,,,,,,,,,,,,,,,,Other,9.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.7,9.7, NF-Toujeo Subcutaneous Solution 300U/1ML,250,RC,,,,1,UN,both,457,319.9,,,,,,,,,,,,,,,,,,,Other,98.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,98.53,98.53, NF-Toujeo Subcutaneous Solution 300U/1ML,250,RC,,,,1,UN,both,457,319.9,,,,,,,,,,,,,,,,,,,Other,98.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,98.53,98.53, NF-HumaLOG KwikPen SubQ Soln 100U/ML,250,RC,,,,1,UN,both,50,35,,,,,,,,,,,,,,,,,,,Other,10.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.78,10.78, NF-HumaLOG KwikPen SubQ Soln 100U/ML,250,RC,,,,1,UN,both,50,35,,,,,,,,,,,,,,,,,,,Other,10.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.78,10.78, NF-Enablex Tablet Extended-Release 15MG,250,RC,,,,1,ME,both,24,16.8,,,,,,,,,,,,,,,,,,,Other,5.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.17,5.17, NF-Methadone Oral Tablet 5MG,250,RC,,,,1,ME,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-Methadone Oral Tablet 5MG,250,RC,,,,1,ME,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-SYNTHROID ORAL TABLET 175MCG,250,RC,,,,1,ME,both,3.67,2.57,,,,,,,,,,,,,,,,,,,Other,0.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.79,0.79, NF-AMLODIPINE-OLMESARTAN ORAL TAB 5MG-20,250,RC,,,,1,ME,both,31.37,21.96,,,,,,,,,,,,,,,,,,,Other,6.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.76,6.76, NF-Systane Ophth Solution,250,RC,,,,1,ML,both,2,1.4,,,,,,,,,,,,,,,,,,,Other,0.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.43,0.43, NF-SIMVASTATIN ORAL TABLET 20MG,250,RC,,,,1,ME,both,19.68,13.78,,,,,,,,,,,,,,,,,,,Other,4.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.24,4.24, NF-JOURNAVX ORAL TABLET 50MG,250,RC,,,,1,ME,both,74.4,52.08,,,,,,,,,,,,,,,,,,,Other,16.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.04,16.04, NF-Ciprofloxacin Otic Solution 0.2%,250,RC,,,,1,EA,both,37,25.9,,,,,,,,,,,,,,,,,,,Other,7.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.98,7.98, NF-Ciprofloxacin Otic Solution 0.2%,250,RC,,,,1,ML,both,37,25.9,,,,,,,,,,,,,,,,,,,Other,7.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.98,7.98, NF-CARDIZEM CD 24 HR CAP ER 360MG,250,RC,,,,1,ME,both,446.36,312.45,,,,,,,,,,,,,,,,,,,Other,96.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,96.24,96.24, NF-Visine Dry Eye Relief Ophth Soln 1%,250,RC,,,,1,EA,both,2,1.4,,,,,,,,,,,,,,,,,,,Other,0.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.43,0.43, NF-dexAMETHasone/Neomy/Polymyxin Opth Oi,250,RC,,,,1,EA,both,22,15.4,,,,,,,,,,,,,,,,,,,Other,4.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.74,4.74, NF-Neomycin/Polymyxin/dexAMETHasone Oint,250,RC,,,,1,EA,both,17,11.9,,,,,,,,,,,,,,,,,,,Other,3.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.67,3.67, NF-Rosuvastatin Oral Tablet 20MG,250,RC,,,,1,ME,both,35,24.5,,,,,,,,,,,,,,,,,,,Other,7.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.55,7.55, NF-oxyBUTYnin ER Oral Tab ER 15MG,250,RC,,,,1,ME,both,28,19.6,,,,,,,,,,,,,,,,,,,Other,6.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.04,6.04, NF-oxyBUTYnin ER Oral Tab ER 15MG,250,RC,,,,1,ME,both,28,19.6,,,,,,,,,,,,,,,,,,,Other,6.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.04,6.04, NF-Wellbutrin SR 12 Hr Tab ER 100MG,250,RC,,,,1,ME,both,35,24.5,,,,,,,,,,,,,,,,,,,Other,7.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.55,7.55, NF-Citalopram Oral Tablet 20MG,250,RC,,,,1,ME,both,10,7,,,,,,,,,,,,,,,,,,,Other,2.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.16,2.16, NF-Pravastatin Sodium Oral Tablet 40MG,250,RC,,,,1,ME,both,19,13.3,,,,,,,,,,,,,,,,,,,Other,4.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.1,4.1, NF-Modafinil Oral Tablet 200MG,250,RC,,,,1,ME,both,159,111.3,,,,,,,,,,,,,,,,,,,Other,34.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.28,34.28, NF-Trelegy Ellipta 100/62.5/25MCG/INH,250,RC,,,,1,EA,both,54,37.8,,,,,,,,,,,,,,,,,,,Other,11.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.64,11.64, NF-MUCINEX EXTENDED-RELEASE TABLET 1200M,250,RC,,,,1,ME,both,4.37,3.06,,,,,,,,,,,,,,,,,,,Other,0.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.94,0.94, NF-SALONPAS TOPICAL PATCH ER 4%,250,RC,,,,1,EA,both,8.66,6.06,,,,,,,,,,,,,,,,,,,Other,1.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.87,1.87, NF-Modafinil Oral Tablet 100MG,250,RC,,,,1,ME,both,105,73.5,,,,,,,,,,,,,,,,,,,Other,22.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,22.64,22.64, NF-Naltrexone Oral Tablet 50MG,250,RC,,,,1,ME,both,18,12.6,,,,,,,,,,,,,,,,,,,Other,3.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.88,3.88, NF-Naltrexone Oral Tablet 50MG,250,RC,,,,1,ME,both,18,12.6,,,,,,,,,,,,,,,,,,,Other,3.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.88,3.88, NF-Tandem Mobi AutoSoft30 14PK 23 Inch,250,RC,,,,1,EA,both,64,44.8,,,,,,,,,,,,,,,,,,,Other,13.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.8,13.8, NF-Tandem Mobi AutoSoftXC 14PK 23 Inch,250,RC,,,,1,EA,both,97,67.9,,,,,,,,,,,,,,,,,,,Other,20.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,20.91,20.91, NF-DAPTOmycin-Sodium Ch IV 700MG/100ML-0,250,RC,,,,1,ME,both,2,1.4,,,,,,,,,,,,,,,,,,,Other,0.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.43,0.43, NF-CeleXA Tablet 20MG,250,RC,,,,1,ME,both,45,31.5,,,,,,,,,,,,,,,,,,,Other,9.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.7,9.7, NF-CeleXA Tablet 20MG,250,RC,,,,1,ME,both,45,31.5,,,,,,,,,,,,,,,,,,,Other,9.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.7,9.7, NF-dofetilide Oral Capsule 125MCG,250,RC,,,,1,ME,both,34,23.8,,,,,,,,,,,,,,,,,,,Other,7.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.33,7.33, NF-dilTIAZem HCl Tablet 90MG,250,RC,,,,1,ME,both,3,2.1,,,,,,,,,,,,,,,,,,,Other,0.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.65,0.65, NF-amLODIPine-OLMESARTAN ORAL TAB 5MG-40,250,RC,,,,1,ME,both,39.67,27.77,,,,,,,,,,,,,,,,,,,Other,8.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.56,8.56, NF-Colace Liquid Capsule 100MG,250,RC,,,,1,ME,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-RELPAX ORAL TABLET 40MG,250,RC,,,,1,ME,both,114.09,79.86,,,,,,,,,,,,,,,,,,,Other,24.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.6,24.6, NF-VICKS VAPORUB OINTMENT,250,RC,,,,1,EA,both,0.25,0.18,,,,,,,,,,,,,,,,,,,Other,0.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.06,0.06, NF-DHEA Capsule 50MG,250,RC,,,,1,ME,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-Ferrex 150 Plus Oral Cap 150MG-50MG-5,250,RC,,,,1,ME,both,5,3.5,,,,,,,,,,,,,,,,,,,Other,1.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.08,1.08, NF-Iron Polysaccharide Complex 150MG,250,RC,,,,1,ME,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-Lisinopril Tablet 2.5mg,250,RC,,,,1,ME,both,2,1.4,,,,,,,,,,,,,,,,,,,Other,0.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.43,0.43, NF-Cartia XT Oral 24 Hr Cap ER 180MG,250,RC,,,,1,ME,both,5,3.5,,,,,,,,,,,,,,,,,,,Other,1.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.08,1.08, NF-Suprep Bowel Prep Kit Oral Solution,250,RC,,,,1,EA,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-Jardiance Oral Tablet 10MG,250,RC,,,,1,ME,both,100,70,,,,,,,,,,,,,,,,,,,Other,21.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,21.56,21.56, NF-TAGAMET HB TAB 200MG,250,RC,,,,1,ME,both,1.55,1.09,,,,,,,,,,,,,,,,,,,Other,0.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.33,0.33, NF-BENAZEPRIL HCL/HCTZ TABLET 20/12.5MG,250,RC,,,,1,ME,both,2.85,2,,,,,,,,,,,,,,,,,,,Other,0.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.62,0.62, NF-LOTENSIN HCT TABLET 20MG-12.5MG,250,RC,,,,1,ME,both,12.79,8.95,,,,,,,,,,,,,,,,,,,Other,2.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.75,2.75, NF-Insulin Degludec FlexTouch 100U/1ML,250,RC,,,,1,UN,both,3,2.1,,,,,,,,,,,,,,,,,,,Other,0.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.65,0.65, NF-Provigil Oral Tablet 100MG,250,RC,,,,1,ME,both,267,186.9,,,,,,,,,,,,,,,,,,,Other,57.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,57.57,57.57, NF-Gabapentin Oral Capsule 300MG,250,RC,,,,1,ME,both,5,3.5,,,,,,,,,,,,,,,,,,,Other,1.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.08,1.08, NF-Midodrine HCl Tablet 10MG,250,RC,,,,1,ME,both,19,13.3,,,,,,,,,,,,,,,,,,,Other,4.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.1,4.1, NF-dilTIAZem HCl 24Hr Capsule ER 240MG,250,RC,,,,1,ME,both,8,5.6,,,,,,,,,,,,,,,,,,,Other,1.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.72,1.72, NF-rOPINIRole HCL AVPAK TAB 0.25MG,250,RC,,,,1,ME,both,2.36,1.65,,,,,,,,,,,,,,,,,,,Other,0.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.51,0.51, SUZETRIGINE 50MG TABLET(JOURNAVX),250,RC,,,,1,ME,both,79.98,55.99,,,,,,,,,,,,,,,,,,,Other,17.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.25,17.25, NF-DILTIAZEM HCL ORAL CAPSULE ER 12HR 60,250,RC,,,,1,ME,both,13.83,9.68,,,,,,,,,,,,,,,,,,,Other,2.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.98,2.98, NF-Coreg Tablet 25MG,250,RC,,,,1,ME,both,34,23.8,,,,,,,,,,,,,,,,,,,Other,7.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.33,7.33, NF-Modafinil Oral Tablet 200MG,250,RC,,,,1,ME,both,159,111.3,,,,,,,,,,,,,,,,,,,Other,34.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,34.28,34.28, NF-POTASSIUM GLUCONATE ORAL TABLET 595MG,250,RC,,,,1,ME,both,0.16,0.11,,,,,,,,,,,,,,,,,,,Other,0.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.04,0.04, NF-Brimonidine-Timolol Ophth Soln 0.2%-0,250,RC,,,,1,EA,both,177,123.9,,,,,,,,,,,,,,,,,,,Other,38.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,38.16,38.16, NF-metFORMIN HCl Tablet 1000MG,250,RC,,,,1,ME,both,5,3.5,,,,,,,,,,,,,,,,,,,Other,1.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.08,1.08, NF-Methotrexate Oral Tablet 2.5MG,250,RC,,,,1,ME,both,16,11.2,,,,,,,,,,,,,,,,,,,Other,3.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.45,3.45, NF-Relafen Oral Tablet 500MG,250,RC,,,,1,ME,both,121,84.7,,,,,,,,,,,,,,,,,,,Other,26.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.09,26.09, NF-PROGESTERONE LIQ CAP 200MG,250,RC,,,,1,ME,both,152.05,106.44,,,,,,,,,,,,,,,,,,,Other,32.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,32.78,32.78, NF-HCTZ/Triamterene Tablet 50MG-75MG,250,RC,,,,1,ME,both,3,2.1,,,,,,,,,,,,,,,,,,,Other,0.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.65,0.65, NF-Gastrografin Solution,250,RC,,,,1,EA,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-Gastrografin Solution,250,RC,,,,1,EA,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-buPROPion Hydrochloride Tablet 100MG,250,RC,,,,1,ME,both,3,2.1,,,,,,,,,,,,,,,,,,,Other,0.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.65,0.65, NF-Zytiga Oral Tablet 250MG,250,RC,,,,1,ME,both,478,334.6,,,,,,,,,,,,,,,,,,,Other,103.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,103.06,103.06, NF-Breztri Aerosphere Inh Aer Liq,250,RC,,,,1,ME,both,298,208.6,,,,,,,,,,,,,,,,,,,Other,64.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,64.25,64.25, NF-PreserVision Areds2+Multi Liq Cap,250,RC,,,,1,ME,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-CeleBREX Oral Capsule 100MG,250,RC,,,,1,ME,both,48,33.6,,,,,,,,,,,,,,,,,,,Other,10.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,10.35,10.35, NF-Pravastatin Sodium Oral Tablet 40MG,250,RC,,,,1,ME,both,19,13.3,,,,,,,,,,,,,,,,,,,Other,4.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.1,4.1, NF-Adderall Oral Tablet 20MG,250,RC,,,,1,ME,both,56,39.2,,,,,,,,,,,,,,,,,,,Other,12.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.07,12.07, NF-BUSPIRONE HCL ORAL TABLET 15MG,250,RC,,,,1,ME,both,11.67,8.17,,,,,,,,,,,,,,,,,,,Other,2.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.52,2.52, NF-CASODEX TAB 50MG,250,RC,,,,1,ME,both,527.38,369.17,,,,,,,,,,,,,,,,,,,Other,113.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,113.7,113.7, NF-Depo-Testosterone IM Oil 100MG/1ML,250,RC,,,,1,ME,both,41,28.7,,,,,,,,,,,,,,,,,,,Other,8.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.84,8.84, NF-Dorzolamide Hydrochloride Ophth Soln,250,RC,,,,1,EA,both,26,18.2,,,,,,,,,,,,,,,,,,,Other,5.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.61,5.61, NF-Ipratropium Brom Nasal Spray 0.03%,250,RC,,,,1,EA,both,22,15.4,,,,,,,,,,,,,,,,,,,Other,4.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.74,4.74, NF-Citalopram Oral Tablet 20MG,250,RC,,,,1,ME,both,10,7,,,,,,,,,,,,,,,,,,,Other,2.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.16,2.16, NF-NexIUM Capsule 20MG,250,RC,,,,1,ME,both,44,30.8,,,,,,,,,,,,,,,,,,,Other,9.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.49,9.49, NF-ESTER-C W/BIOFLAVONOID COMPLEX TABLET,250,RC,,,,1,ME,both,0.24,0.17,,,,,,,,,,,,,,,,,,,Other,0.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.05,0.05, NF-ACULAR OPHTHALMIC SOLUTION 0.5%,250,RC,,,,1,EA,both,86.95,60.87,,,,,,,,,,,,,,,,,,,Other,18.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.75,18.75, NF-Levothyroxine Sodium Oral Tablet 88MC,250,RC,,,,1,ME,both,2,1.4,,,,,,,,,,,,,,,,,,,Other,0.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.43,0.43, NF-Colestid Oral Tablet 1GM,250,RC,,,,1,ME,both,10,7,,,,,,,,,,,,,,,,,,,Other,2.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.16,2.16, NF-Trelegy Ellipta 100/62.5/25MCG/INH,250,RC,,,,1,EA,both,54,37.8,,,,,,,,,,,,,,,,,,,Other,11.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11.64,11.64, NF-predniSONE Tablet 50MG,250,RC,,,,1,ME,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-MOUNJARO SUBQ SOLN 2.5MG/0.5ML,250,RC,,,,1,ME,both,2591.44,1814.01,,,,,,,,,,,,,,,,,,,Other,558.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,558.72,558.72, NF-LUBIPROSTONE LIQ CAP 24MCG,250,RC,,,,1,ME,both,18.14,12.7,,,,,,,,,,,,,,,,,,,Other,3.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.91,3.91, NF-ROSUVASTATIN CALCIUM ORAL TABLET 5MG,250,RC,,,,1,ME,both,38.18,26.73,,,,,,,,,,,,,,,,,,,Other,8.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.23,8.23, NF-fentaNYL Transdermal Patch ER 12MCG/H,250,RC,,,,1,ME,both,81,56.7,,,,,,,,,,,,,,,,,,,Other,17.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.46,17.46, NF-Entacapone Oral Tablet 200MG,250,RC,,,,1,ME,both,15,10.5,,,,,,,,,,,,,,,,,,,Other,3.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.23,3.23, NF-Carbidopa/Levodopa Tablet 50MG-200MG,250,RC,,,,1,ME,both,7,4.9,,,,,,,,,,,,,,,,,,,Other,1.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.51,1.51, NF-Depo-Testosterone IM Oil 200MG/1ML,250,RC,,,,1,ME,both,114,79.8,,,,,,,,,,,,,,,,,,,Other,24.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.58,24.58, NF-Depo-Testosterone IM Oil 200MG/1ML,250,RC,,,,1,ME,both,114,79.8,,,,,,,,,,,,,,,,,,,Other,24.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,24.58,24.58, NF-Alfuzosin Hydrochloride Oral Tab ER 1,250,RC,,,,1,ME,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-NORTRIPTYLINE HCL CAP 25MG,250,RC,,,,1,ME,both,0.87,0.61,,,,,,,,,,,,,,,,,,,Other,0.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.19,0.19, NF-CeleBREX Oral Capsule 50MG,250,RC,,,,1,ME,both,22,15.4,,,,,,,,,,,,,,,,,,,Other,4.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.74,4.74, NF-Amitriptyline Oral Tablet 10MG,250,RC,,,,1,ME,both,3,2.1,,,,,,,,,,,,,,,,,,,Other,0.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.65,0.65, NF-TYENNE AUTOINJECTOR SUBQ 162MG/0.9ML,250,RC,,,,1,ME,both,4072.71,2850.9,,,,,,,,,,,,,,,,,,,Other,878.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,878.08,878.08, NF-CLOZAPINE ORAL TABLET 100MG,250,RC,,,,1,ME,both,5.64,3.95,,,,,,,,,,,,,,,,,,,Other,1.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.22,1.22, NF-COBENFY CAP 100MG-20MG,250,RC,,,,1,ME,both,148,103.6,,,,,,,,,,,,,,,,,,,Other,31.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,31.91,31.91, NF-Citalopram Hydrobromide Tablet 20MG,250,RC,,,,1,ME,both,10,7,,,,,,,,,,,,,,,,,,,Other,2.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.16,2.16, NF-Wes-Phos 250 Neutral Oral Tablet,250,RC,,,,1,ME,both,2,1.4,,,,,,,,,,,,,,,,,,,Other,0.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.43,0.43, NF-Topiramate Oral Tablet 100MG,250,RC,,,,1,ME,both,21,14.7,,,,,,,,,,,,,,,,,,,Other,4.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.53,4.53, NF-Nortriptyline Oral Capsule 10MG,250,RC,,,,1,ME,both,2,1.4,,,,,,,,,,,,,,,,,,,Other,0.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.43,0.43, NF-Nurtec ODT Oral Dis Tablet 75MG,250,RC,,,,1,ME,both,617,431.9,,,,,,,,,,,,,,,,,,,Other,133.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,133.03,133.03, NF-Wixela Inhub Inhalation Disk 100/50,250,RC,,,,1,EA,both,24,16.8,,,,,,,,,,,,,,,,,,,Other,5.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.17,5.17, NF-PNEUMOCOCCAL VACCINE POLYVALENT INJ S,250,RC,,,,1,ME,both,1123.98,786.79,,,,,,,,,,,,,,,,,,,Other,242.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,242.33,242.33, NF-Paxlovid Oral Tab 300MG;100MG,250,RC,,,,1,ME,both,239,167.3,,,,,,,,,,,,,,,,,,,Other,51.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,51.53,51.53, NF-Benzonatate Oral Liq Cap 200MG,250,RC,,,,1,ME,both,7,4.9,,,,,,,,,,,,,,,,,,,Other,1.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.51,1.51, NF-Doxepin Oral Capsule 10MG,250,RC,,,,1,ME,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-Ondansetron Oral Tablet 4MG,250,RC,,,,1,ME,both,99,69.3,,,,,,,,,,,,,,,,,,,Other,21.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,21.34,21.34, NF-Doxepin HCl Oral Capsule 25MG,250,RC,,,,1,ME,both,3,2.1,,,,,,,,,,,,,,,,,,,Other,0.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.65,0.65, NF-Theophylline Oral Solution 80MG/15ML,250,RC,,,,1,ME,both,3,2.1,,,,,,,,,,,,,,,,,,,Other,0.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.65,0.65, NF-Pramipexole Dihydrochloride Tab 0.25M,250,RC,,,,1,ME,both,11,7.7,,,,,,,,,,,,,,,,,,,Other,2.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.37,2.37, NF-Breo Ellipta Inh Pwd 100MCG/1Actuatio,250,RC,,,,1,EA,both,32,22.4,,,,,,,,,,,,,,,,,,,Other,6.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.9,6.9, NF-Citalopram Oral Tablet 40MG,250,RC,,,,1,ME,both,10,7,,,,,,,,,,,,,,,,,,,Other,2.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.16,2.16, NF-fluvoxaMINE Maleate Tablet 100MG,250,RC,,,,1,ME,both,10,7,,,,,,,,,,,,,,,,,,,Other,2.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.16,2.16, NF-PreserVision AREDS 2 Oral Chew Tab,250,RC,,,,1,EA,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-PreserVision AREDS 2 Liq Cap,250,RC,,,,1,EA,both,1,0.7,,,,,,,,,,,,,,,,,,,Other,0.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.22,0.22, NF-GLIPIZIDE AVPAK ORAL TABLET 10MG,250,RC,,,,1,ME,both,3.03,2.12,,,,,,,,,,,,,,,,,,,Other,0.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.66,0.66, NF-FLUTICASONE FUROATE INH PWD 100MCG/1A,250,RC,,,,1,EA,both,31.69,22.18,,,,,,,,,,,,,,,,,,,Other,6.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.83,6.83, NF-QUETIAPINE FUMARATE ORAL TAB ER 150MG,250,RC,,,,1,ME,both,63.7,44.59,,,,,,,,,,,,,,,,,,,Other,13.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,13.73,13.73, NF-PREDNISOLONE ACETATE OPHTH SUSP 1%,250,RC,,,,1,EA,both,42.24,29.57,,,,,,,,,,,,,,,,,,,Other,9.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.1,9.1, NF-Narcan Nasal Spray 4MG/0.1ML,250,RC,,,,1,ME,both,300,210,,,,,,,,,,,,,,,,,,,Other,64.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,64.68,64.68, NF-Linzess Oral Capsule 290MCG,250,RC,,,,1,ME,both,90,63,,,,,,,,,,,,,,,,,,,Other,19.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.4,19.4, NF-Simvastatin Oral Tablet 80MG,250,RC,,,,1,ME,both,19,13.3,,,,,,,,,,,,,,,,,,,Other,4.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.1,4.1, NF-DAPAGLIFLOZIN ORAL TABLET 10MG,250,RC,,,,1,ME,both,88.5,61.95,,,,,,,,,,,,,,,,,,,Other,19.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.08,19.08, NF-Indapamide Tablet 1.25MG,250,RC,,,,1,ME,both,2,1.4,,,,,,,,,,,,,,,,,,,Other,0.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.43,0.43, NF-Atorvastatin Calcium Oral Tab 80MG,250,RC,,,,1,ME,both,23,16.1,,,,,,,,,,,,,,,,,,,Other,4.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.96,4.96, NF-Soliqua SC Solution 100U-33MCG/1ML,250,RC,,,,1,ME,both,285,199.5,,,,,,,,,,,,,,,,,,,Other,61.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,61.45,61.45, NF-Pravastatin Oral Tablet 20MG,250,RC,,,,1,ME,both,13,9.1,,,,,,,,,,,,,,,,,,,Other,2.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.8,2.8, NF-traMADol HCl Tablet 50mg,250,RC,,,,1,ME,both,3,2.1,,,,,,,,,,,,,,,,,,,Other,0.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.65,0.65, NF-ISOSORBIDE MONONITRATE TAB 10MG,250,RC,,,,1,ME,both,14.16,9.91,,,,,,,,,,,,,,,,,,,Other,3.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,3.06,3.06, NF-ISOSORBIDE MONONITRATE TAB 10MG,250,RC,,,,1,ME,both,30.48,21.34,,,,,,,,,,,,,,,,,,,Other,6.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.58,6.58, NF-Lisinopril Tablet 5mg,250,RC,,,,1,ME,both,3,2.1,,,,,,,,,,,,,,,,,,,Other,0.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.65,0.65, NF-Atovaquone Oral Suspension 750MG/5ML,250,RC,,,,1,ME,both,26,18.2,,,,,,,,,,,,,,,,,,,Other,5.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.61,5.61, NF-Atovaquone Oral Suspension 750MG/5ML,250,RC,,,,1,ME,both,26,18.2,,,,,,,,,,,,,,,,,,,Other,5.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,5.61,5.61, "NF-NIFEdipine Tablet, Extended-Release 3",250,RC,,,,1,EA,both,5,3.5,,,,,,,,,,,,,,,,,,,Other,1.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.08,1.08, LOSARTAN 50MG TAB (COZAAR),637,RC,,,,1,ME,both,10.23,7.16,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ADMIN FLU SHOT MC,G0008,HCPCS,771,RC,,,,both,35,24.5,,,,,,,,,,,,,,,,,,,Other,7.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.55,7.55, ADMIN PNEUMOVAX MC,G0009,HCPCS,771,RC,,,,both,35,24.5,,,,,,,,,,,,,,,,,,,Other,7.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.55,7.55, CL-MENQUADFI VACCINE,90619,HCPCS,636,RC,,1,EA,both,281,196.7,,,,,,,,,,,,,,,,,,,Other,60.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,60.58,60.58, ADMIN HEPATITIS VACCINE ADMIN MC,G0010,HCPCS,771,RC,,,,both,35,24.5,,,,,,,,,,,,,,,,,,,Other,7.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.55,7.55, "CL-HEPATITIS A VACCINE, ADULT DOSE",90632,HCPCS,636,RC,,1,EA,both,144,100.8,,,,,,,,,,,,,,,,,,,Other,31.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,72.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.05,72.07, CL-HAVRIX HEP A PEDS 2 DOSE SCHED,90633,HCPCS,636,RC,,1,EA,both,92,64.4,,,,,,,,,,,,,,,,,,,Other,19.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,19.84,19.84, CL-PEDVAXHIB HIB-PRP-OMP,90647,HCPCS,636,RC,,1,EA,both,79,55.3,,,,,,,,,,,,,,,,,,,Other,17.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.03,17.03, CL-HIB 1/4-DOSE IM PRP-T CONJUGATE,90648,HCPCS,636,RC,,1,EA,both,69,48.3,,,,,,,,,,,,,,,,,,,Other,14.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,14.88,14.88, CL-HPV GARDASIL,90649,HCPCS,636,RC,,1,EA,both,322,225.4,,,,,,,,,,,,,,,,,,,Other,69.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,69.42,69.42, CL-FLU HI-DOSE FLUAD,90653,HCPCS,636,RC,,1,EA,both,150,105,,,,,,,,,,,,,,,,,,,Other,32.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,96.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,32.34,96.2, CL-FLU PRESERVATIVE FREE <3 YRS,90655,HCPCS,636,RC,,1,EA,both,51,35.7,,,,,,,,,,,,,,,,,,,Other,11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,11,11, CL-FLU VACCINE NO PRESERVATIVE 3&>,90656,HCPCS,636,RC,,1,EA,both,58,40.6,,,,,,,,,,,,,,,,,,,Other,12.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,22.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.5,22.76, PAP SMEAR SCREENING,Q0091,HCPCS,960,RC,,,,both,100,70,,,,,,,,,,,,,,,,,,,Other,18.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,42.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.06,42.9, CL-FLU UNDER AGE 3,90657,HCPCS,636,RC,,1,EA,both,46,32.2,,,,,,,,,,,,,,,,,,,Other,9.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.92,10.81, PELVIC/BREAST EXAM SCREEN,G0101,HCPCS,960,RC,,,,both,45,31.5,,,,,,,,,,,,,,,,,,,Other,28.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,28.58,38.31, MC SCREENING FLEXISIG,G0104,HCPCS,975,RC,,,,both,488,341.6,,,,,,,,,,,,,,,,,,,Other,60.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,196.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.36,196.83, MC COLONOSCOPY SCREENING HIGH RISK,G0105,HCPCS,975,RC,,,,both,1300,910,,,,,,,,,,,,,,,,,,,Other,189.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,356.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,189.88,356.08, CL-FLU >3 SPLIT VIRUS .05ML,90658,HCPCS,636,RC,,1,EA,both,46,32.2,,,,,,,,,,,,,,,,,,,Other,9.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,21.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.92,21.63, CL-FLU AGE 65+,90662,HCPCS,636,RC,,1,EA,both,105,73.5,,,,,,,,,,,,,,,,,,,Other,22.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,96.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,22.64,96.2, MC SCREENING COLONOSCOPY LOW RISK,G0121,HCPCS,975,RC,,,,both,1300,910,,,,,,,,,,,,,,,,,,,Other,190.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,356.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,190.46,356.59, CL-PREVNAR 13 PNEUMO BOOSTER,90670,HCPCS,636,RC,,1,EA,both,414,289.8,,,,,,,,,,,,,,,,,,,Other,89.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,252.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,89.26,252.83, "CL-PREVNAR 20 VACCINE, IM",90677,HCPCS,636,RC,,1,EA,both,342,239.4,,,,,,,,,,,,,,,,,,,Other,73.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,306.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,73.74,306.64, CL-ROTARIX ROTAVIRUS MONOVALENT RV5,90681,HCPCS,636,RC,,1,EA,both,200,140,,,,,,,,,,,,,,,,,,,Other,43.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.12,43.12, "CL-FLUARIX, SINGLE LOW DOSE GSK",90686,HCPCS,636,RC,,1,EA,both,45,31.5,,,,,,,,,,,,,,,,,,,Other,9.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,21.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.7,21.9, CL-FLU VACCINE AFLURIA QUADRIVALENT LOW,90688,HCPCS,636,RC,,1,EA,both,49,34.3,,,,,,,,,,,,,,,,,,,Other,10.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.56,20.46, CL-FLU HI-DOSE FLUAD,90694,HCPCS,636,RC,,1,EA,both,121,84.7,,,,,,,,,,,,,,,,,,,Other,26.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,75.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.09,75.81, CL-KINRIX (DTaP & IPV) PEDS AGE 4-6,90696,HCPCS,636,RC,,1,EA,both,125,87.5,,,,,,,,,,,,,,,,,,,Other,26.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.95,26.95, CL-INFANRIX Dtap <7 YRS ACELLULAR PERTUS,90700,HCPCS,636,RC,,1,EA,both,59,41.3,,,,,,,,,,,,,,,,,,,Other,12.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.72,12.72, CL-DT DIPTH AND TETANUS <7 YRS,90702,HCPCS,636,RC,,1,EA,both,79,55.3,,,,,,,,,,,,,,,,,,,Other,17.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,17.03,17.03, CL-MMR VACCINE,90707,HCPCS,636,RC,,1,EA,both,137,95.9,,,,,,,,,,,,,,,,,,,Other,29.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,29.54,29.54, CL-IPV (POLIO VACCINE SUBQ),90713,HCPCS,636,RC,,1,EA,both,86,60.2,,,,,,,,,,,,,,,,,,,Other,18.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,18.54,18.54, CL-TD PRESERV FREE >7,90714,HCPCS,636,RC,,1,EA,both,62,43.4,,,,,,,,,,,,,,,,,,,Other,13.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.19,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.37,38.19, CL-BOOSTRIX (TET-DIPTH-PERTUSS) >7 YRS,90715,HCPCS,636,RC,,1,EA,both,93,65.1,,,,,,,,,,,,,,,,,,,Other,20.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.05,38.9, CL-VARICELLA VACCINE (CHICKEN POX),90716,HCPCS,636,RC,,1,EA,both,227,158.9,,,,,,,,,,,,,,,,,,,Other,48.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,48.94,48.94, CL-PEDIARIX DTAP/HEPB/IPV,90723,HCPCS,636,RC,,1,EA,both,173,121.1,,,,,,,,,,,,,,,,,,,Other,37.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.3,37.3, CL-PNEUMOVAX 23 PNEUMOCOCCAL VACCINE,90732,HCPCS,636,RC,,1,EA,both,236,165.2,,,,,,,,,,,,,,,,,,,Other,50.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,130.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,50.88,130.8, CL-MENINGOCOCCAL POLYSACCHARID VACCINE,90733,HCPCS,636,RC,,1,EA,both,301,210.7,,,,,,,,,,,,,,,,,,,Other,64.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,64.9,64.9, CONSULT/LOW DOSE LUNG SCREEN,G0296,HCPCS,770,RC,,,,both,30,21,,,,,,,,,,,,,,,,,,,Other,6.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.47,27.82, CL-MENINGOCOCCAL CONJ VACCINE (MENACTRA),90734,HCPCS,636,RC,,1,EA,both,249,174.3,,,,,,,,,,,,,,,,,,,Other,53.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,53.68,53.68, CL-ZOSTAVAX SHINGLES VACCINE SUBQ,90736,HCPCS,636,RC,,1,EA,both,373,261.1,,,,,,,,,,,,,,,,,,,Other,80.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,80.42,80.42, PROLONGED HOSPITAL INPT OR OBS EACH ADDN,G0316,HCPCS,987,RC,,,,both,50,35,,,,,,,,,,,,,,,,,,,Other,31.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,33.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.75,33.88, CL-HEPATITIS B AGE 12-19 (2 DOSE SCHED),90743,HCPCS,636,RC,,1,EA,both,123,86.1,,,,,,,,,,,,,,,,,,,Other,26.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,73.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.52,73.64, "IFOB SCREENING MEDICARE,CLIA WAIVED",G0328,HCPCS,300,RC,QW,,,both,18,12.6,,,,,,,,,,,,,,,,,,,Other,3.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.88,17.64, CL-HEPATITIS B PEDS/ADOL 10 MCG (ENGERIX,90744,HCPCS,636,RC,,1,EA,both,98,68.6,,,,,,,,,,,,,,,,,,,Other,21.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,32.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,21.13,32.54, CL-HEPATITIS B VACCINE ADULT 20 MCG,90746,HCPCS,636,RC,,1,EA,both,153,107.1,,,,,,,,,,,,,,,,,,,Other,32.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,73.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,32.99,73.64, CL-SHINGRIX VACCINE,90750,HCPCS,636,RC,,1,EA,both,276,193.2,,,,,,,,,,,,,,,,,,,Other,59.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,59.51,59.51, CL-BOTOX PER UNIT,J0585,HCPCS,636,RC,,1,UN,both,15,10.5,,,,,,,,,,,,,,,,,,,Other,3.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.23,6.38, CL-ROCEPHIN 250 MG,J0696,HCPCS,636,RC,,1,ME,both,10,7,,,,,,,,,,,,,,,,,,,Other,2.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.45,2.16, SCOOTER EXAMINATION,G0372,HCPCS,960,RC,,,,both,50,35,,,,,,,,,,,,,,,,,,,Other,8.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.7,9.06, CL-CLELESTONE 3MG 1/2CC (BETAMETHASONE),J0702,HCPCS,636,RC,,1,ME,both,12,8.4,,,,,,,,,,,,,,,,,,,Other,2.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.59,6.77, CL-METHYLPREDNISOLONE PER 1 MG (DEPO MED,J1010,HCPCS,636,RC,,1,ME,both,0.5,0.35,,,,,,,,,,,,,,,,,,,Other,0.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.11,0.12, ALCOHOL/SUBSTANCE ABUSE ASSESSMENT,G0396,HCPCS,960,RC,,,,both,40,28,,,,,,,,,,,,,,,,,,,Other,33.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,33.5,36.3, CL-TORADOL 15 MG INJ .5CC,J1885,HCPCS,636,RC,,1,ME,both,9,6.3,,,,,,,,,,,,,,,,,,,Other,1.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.32,1.94, MC WELCOME TO MC PX,G0402,HCPCS,960,RC,,,,both,200,140,,,,,,,,,,,,,,,,,,,Other,130.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,167.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,130.21,167.33, CL-LINCOCIN 300 MG/1ML=1 UNIT,J2010,HCPCS,636,RC,,1,ME,both,12,8.4,,,,,,,,,,,,,,,,,,,Other,2.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.59,5.29, CL-KENALOG 10MG/UNIT 4 UNITS PER CC,J3301,HCPCS,636,RC,,1,ME,both,3,2.1,,,,,,,,,,,,,,,,,,,Other,0.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.65,0.73, CL-VISTARIL 25 MG INJ,J3410,HCPCS,636,RC,,1,ME,both,6,4.2,,,,,,,,,,,,,,,,,,,Other,1.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,5.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.29,5.88, MC 1ST WELLNES PX,G0438,HCPCS,960,RC,,,,both,225,157.5,,,,,,,,,,,,,,,,,,,Other,192.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,167.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,167.02,192.07, MC ANNUAL WELLNESS AFTER 1ST AND 2N,G0439,HCPCS,960,RC,,,,both,170,119,,,,,,,,,,,,,,,,,,,Other,151.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,131.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,131.36,151.07, CL-VITAMIN B12 INJ,J3420,HCPCS,636,RC,,1,ME,both,8,5.6,,,,,,,,,,,,,,,,,,,Other,1.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,0.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,0.63,1.72, SCREENING FOR DEPRESSION IN ADULTS ANNUA,G0444,HCPCS,960,RC,,,,both,25,17.5,,,,,,,,,,,,,,,,,,,Other,9.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.08,17.46, BEHAVIORAL THERAPY FOR OBESITY FACE TO F,G0447,HCPCS,960,RC,,,,both,30,21,,,,,,,,,,,,,,,,,,,Other,30.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,29.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,29.4,30.1, PROLONGED E& M VISIT MEDICARE ONLY EACH,G2212,HCPCS,960,RC,,,,both,50,35,,,,,,,,,,,,,,,,,,,Other,31.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,33.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.4,33.28, POST-OP SHOE MALE,L3260,HCPCS,290,RC,,,,both,40,28,,,,,,,,,,,,,,,,,,,Other,8.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.62,8.62, COCK UP WRIST SPLINT 1608410,L3908,HCPCS,274,RC,,,,both,20,14,,,,,,,,,,,,,,,,,,,Other,4.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.31,4.31, SPLINT SUPPLIES MISC,Q4051,HCPCS,270,RC,,,,both,35,24.5,,,,,,,,,,,,,,,,,,,Other,7.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.55,7.55, WALKING BOOT PNEUMATIC OR VACUUM WITH OR,L4360,HCPCS,274,RC,,,,both,245,171.5,,,,,,,,,,,,,,,,,,,Other,52.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,52.82,52.82, WALKING BOOT,L4386,HCPCS,274,RC,,,,both,125,87.5,,,,,,,,,,,,,,,,,,,Other,26.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,26.95,26.95, SLING 01608388 SLING,A4565,HCPCS,270,RC,,,,both,12,8.4,,,,,,,,,,,,,,,,,,,Other,2.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.59,2.59, WRIST SPLINT 1157482-83,A4570,HCPCS,270,RC,,,,both,35,24.5,,,,,,,,,,,,,,,,,,,Other,7.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,7.55,7.55, AIR CAST MED-LARGE 16007422-23,A4590,HCPCS,270,RC,,,,both,78,54.6,,,,,,,,,,,,,,,,,,,Other,16.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,16.82,16.82, CHAMBER AERO RESP 16000507,A4627,HCPCS,270,RC,,,,both,13.6,9.52,,,,,,,,,,,,,,,,,,,Other,2.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.93,2.93, BP MONITOR AUTOMATIC 1601805,A4670,HCPCS,290,RC,,,,both,40,28,,,,,,,,,,,,,,,,,,,Other,8.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,8.62,8.62, GRADIENT COMPRESSION WRAP NON-ELASTIC BE,A6545,HCPCS,270,RC,,,,both,10,7,,,,,,,,,,,,,,,,,,,Other,2.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.16,2.16, PEAK FLOW METER 160000504,S8110,HCPCS,410,RC,,,,both,21,14.7,,,,,,,,,,,,,,,,,,,Other,4.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,4.53,4.53, MARCAINE/BUPIVACAINE 1MG,C9144,HCPCS,250,RC,,,,both,0.25,0.18,,,,,,,,,,,,,,,,,,,Other,0.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.06,0.06, FNA BX WITH ULTRASOUND GUIDANCE 1ST LESI,10005,HCPCS,975,RC,,,,both,470,329,,,,,,,,,,,,,,,,,,,Other,73.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,126.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,73.08,126.01, FNA BX WITH ULTRASOUND GUIDANCE EACH ADD,10006,HCPCS,975,RC,,,,both,248,173.6,,,,,,,,,,,,,,,,,,,Other,50.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,58.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,50.23,58.93, FNA BX W/CT GUIDANCE 1ST LESION,10009,HCPCS,975,RC,,,,both,1565,1095.5,,,,,,,,,,,,,,,,,,,Other,108.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,380.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,108.72,380.24, FNA W/O IMAGING 25 GUAGE AND OVER,10021,HCPCS,975,RC,,,,both,394,275.8,,,,,,,,,,,,,,,,,,,Other,54.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,96.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,54.13,96.08, IMAGE GUIDED FLUID DRAINAGESOFT TIS,10030,HCPCS,975,RC,,,,both,941,658.7,,,,,,,,,,,,,,,,,,,Other,139,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,570.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,139,570.64, PLACE SOFT TISSUE LOCALIZATION DEVICE(CL,10035,HCPCS,975,RC,,,,both,1000,700,,,,,,,,,,,,,,,,,,,Other,82.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,317.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,82.8,317.35, EACH ADD'L LESION--PLACE SOFT TISSUE LOC,10036,HCPCS,975,RC,,,,both,700,490,,,,,,,,,,,,,,,,,,,Other,43.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,264.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,43.21,264.71, ACNE SURGERY (OPENING/REMOVAL OF MILIA C,10040,HCPCS,975,RC,,,,both,250,175,,,,,,,,,,,,,,,,,,,Other,48.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,105.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.52,105.55, INCISION AND DRAINAGE 10G,10060,HCPCS,975,RC,,,,both,281,196.7,,,,,,,,,,,,,,,,,,,Other,110.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,121.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,110.52,121.22, I&D ABSCESS COMP/MULT 10G,10061,HCPCS,975,RC,,,,both,459,321.3,,,,,,,,,,,,,,,,,,,Other,194.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,210.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,194.28,210.77, INCISION / DRAINAGE PILONIDAL CYST,10080,HCPCS,975,RC,,,,both,522,365.4,,,,,,,,,,,,,,,,,,,Other,117.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,248.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,117.05,248.81, I/D PILONBIDAL CYST COMPLICATED,10081,HCPCS,975,RC,,,,both,727,508.9,,,,,,,,,,,,,,,,,,,Other,193.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,357.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,193.3,357.25, REMOVAL FB W/ INCISION 10G,10120,HCPCS,975,RC,,,,both,358,250.6,,,,,,,,,,,,,,,,,,,Other,112.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,147.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,112.48,147.13, FB INCIS&REMOVAL COMPL G10,10121,HCPCS,975,RC,,,,both,675,472.5,,,,,,,,,,,,,,,,,,,Other,194.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,261.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,194.69,261.94, I&D HEMATOMA SEROMA 10G,10140,HCPCS,975,RC,,,,both,394,275.8,,,,,,,,,,,,,,,,,,,Other,129.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,164.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,129.1,164.86, PUNCT ASPIR ABSC CYST HEMATOMA 10G,10160,HCPCS,975,RC,,,,both,365,255.5,,,,,,,,,,,,,,,,,,,Other,102.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,124.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,102.09,124.63, INC AND DRAIN WOUND INFECTION 10G,10180,HCPCS,975,RC,,,,both,755,528.5,,,,,,,,,,,,,,,,,,,Other,200.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,274.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,200.35,274.93, DEBRIDEMENT OF SKIN 00,11000,HCPCS,975,RC,,,,both,127,88.9,,,,,,,,,,,,,,,,,,,Other,28.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,55.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,28.24,55.64, DEBRIDE ECZEMAOR INFECTED SKIN +10%,11001,HCPCS,975,RC,,,,both,72,50.4,,,,,,,,,,,,,,,,,,,Other,14.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,25.67,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.74,25.67, ABD WALL 2ND DEB/?CLOSE FASC/MUS 00,11005,HCPCS,975,RC,,,,both,2558,1790.6,,,,,,,,,,,,,,,,,,,Other,842.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,732.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,732.75,842.66, "ASST DEB ABD WALL W/WO FASC,ASSISTANT SURGEON",11005,HCPCS,975,RC,80,,,both,509,356.3,,,,,,,,,,,,,,,,,,,Other,134.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,117.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,117.24,134.83, MESH REMOVAL ABD WALL,11008,HCPCS,975,RC,,,,both,998,698.6,,,,,,,,,,,,,,,,,,,Other,298.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,259.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,259.25,298.14, "ASST MESH REMOVAL ABD WALL,ASSISTANT SURGEON",11008,HCPCS,975,RC,80,,,both,250,175,,,,,,,,,,,,,,,,,,,Other,47.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,41.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,41.48,47.71, DEBRIDE REMOVE FB SKIN SUBQ,11010,HCPCS,975,RC,,,,both,1356,949.2,,,,,,,,,,,,,,,,,,,Other,288.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,447.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,288.48,447.49, DEBRIDEMENT SKIN SUBQ MUSC FASC,11011,HCPCS,975,RC,,,,both,1525,1067.5,,,,,,,,,,,,,,,,,,,Other,311.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,515.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,311.57,515.09, DEBRIDE COMPLEX TO BONE,11012,HCPCS,975,RC,,,,both,2218,1552.6,,,,,,,,,,,,,,,,,,,Other,427.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,661.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,427.13,661.61, DEBRIDEMENT SKIN SUBQ 1ST 20 SQ 00G,11042,HCPCS,975,RC,,,,both,318,222.6,,,,,,,,,,,,,,,,,,,Other,63.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,124.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,63.79,124.21, DEBRIDEMENT SKIN SUBQ MUS 0G,11043,HCPCS,975,RC,,,,both,657,459.9,,,,,,,,,,,,,,,,,,,Other,161.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,230.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,161.17,230.7, DEBRIDE SKIN MUSCLE BONE 0G,11044,HCPCS,975,RC,,,,both,949,664.3,,,,,,,,,,,,,,,,,,,Other,235.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,311.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,235.66,311.9, DEBRIDE ADDTL 20 SQ CM SUB Q,11045,HCPCS,975,RC,,,,both,119,83.3,,,,,,,,,,,,,,,,,,,Other,26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,40.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26,40.24, DEBRIDE ADDL 20 SQ CM MUSCLE AND/OR FASC,11046,HCPCS,960,RC,,,,both,198,138.6,,,,,,,,,,,,,,,,,,,Other,57.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,75.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,57.08,75.32, PARING SKIN LESION,11055,HCPCS,975,RC,,,,both,120,84,,,,,,,,,,,,,,,,,,,Other,15.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,64.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.93,64.37, TANGENTIAL BIOPSY OF SKIN SINGLE LESION,11102,HCPCS,975,RC,,,,both,244,170.8,,,,,,,,,,,,,,,,,,,Other,34.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,88.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.5,88.57, TANGENTIAL BIOPSY EACH ADDT LESION,11103,HCPCS,975,RC,,,,both,131,91.7,,,,,,,,,,,,,,,,,,,Other,20.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,45.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.41,45.54, PUNCH BIOPSY OF SKIN SNG LESN SIMPLE CLO,11104,HCPCS,975,RC,,,,both,312,218.4,,,,,,,,,,,,,,,,,,,Other,44.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,112.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,44.03,112.7, PUNCH BIOP EACH ADDTNL LESION,11105,HCPCS,975,RC,,,,both,158,110.6,,,,,,,,,,,,,,,,,,,Other,25.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,56.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,25.16,56.83, INCISIONAL BX OF SKIN (WEDGE); SINGLE LE,11106,HCPCS,975,RC,,,,both,361,252.7,,,,,,,,,,,,,,,,,,,Other,53.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,140.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,53.92,140.73, INCISIONAL BX OF SKIN (WEDGE); EA ADDNL,11107,HCPCS,975,RC,,,,both,170,119,,,,,,,,,,,,,,,,,,,Other,28.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,66.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,28.98,66.14, SKIN TAGS REMOVAL UP TO 15 10G,11200,HCPCS,975,RC,,,,both,209,146.3,,,,,,,,,,,,,,,,,,,Other,75.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,86.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,75.72,86.47, SKIN TAG 10 ADDTL BENIGN LESIONS,11201,HCPCS,975,RC,,,,both,66,46.2,,,,,,,,,,,,,,,,,,,Other,15.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.05,17.88, SHAVING OF EPIDERMAL SINGLE LESION,11300,HCPCS,975,RC,,,,both,225,157.5,,,,,,,,,,,,,,,,,,,Other,31.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,89.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.93,89.33, SHAVING SKIN LESION .6-1.0 CM 10G,11301,HCPCS,975,RC,,,,both,271,189.7,,,,,,,,,,,,,,,,,,,Other,47.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,108.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,47.79,108.21, SHAVING LESION 1.1-2.0,11302,HCPCS,975,RC,,,,both,298,208.6,,,,,,,,,,,,,,,,,,,Other,55.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,122.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,55.38,122.57, SHAVING EPIDERMAL LESION >2.0,11303,HCPCS,975,RC,,,,both,326,228.2,,,,,,,,,,,,,,,,,,,Other,66.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,138.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,66.63,138.03, SHAVE LESION SNHFG 0.5 CM OR LESS,11305,HCPCS,975,RC,,,,both,195,136.5,,,,,,,,,,,,,,,,,,,Other,37.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,94.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,37.95,94.27, SHAVING OF EPID/DERMAL LES .6-1.0CM,11306,HCPCS,975,RC,,,,both,242,169.4,,,,,,,,,,,,,,,,,,,Other,46.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,109.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,46.96,109.88, SHAVING LESION SNHFG 1.1-2.0,11307,HCPCS,975,RC,,,,both,281,196.7,,,,,,,,,,,,,,,,,,,Other,59.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,124.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,59.45,124.02, SHAVE EXCISION LESION >2 CM,11308,HCPCS,975,RC,,,,both,298,208.6,,,,,,,,,,,,,,,,,,,Other,69.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,132.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,69.34,132.62, SHAVING EPIDERMAL LESION FACE EYE,11310,HCPCS,975,RC,,,,both,256,179.2,,,,,,,,,,,,,,,,,,,Other,41.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,103.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,41.73,103.53, SHAVING LESION FACE MUCOUS MEM .6-1,11311,HCPCS,975,RC,,,,both,285,199.5,,,,,,,,,,,,,,,,,,,Other,58.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,123.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,58.44,123.73, SHAVE LESION FEENLM 1.1 TO 2.0 CM,11312,HCPCS,975,RC,,,,both,326,228.2,,,,,,,,,,,,,,,,,,,Other,69.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,141.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,69.55,141.17, SHAVING EPIDERMAL LESION >2.0 CM,11313,HCPCS,975,RC,,,,both,387,270.9,,,,,,,,,,,,,,,,,,,Other,88.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,166.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,88.93,166.38, EXC BEN LES TAL <=0.5CM 10G,11400,HCPCS,975,RC,,,,both,294,205.8,,,,,,,,,,,,,,,,,,,Other,84.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,119.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,84.28,119.31, EXC BEN LES TAL .6-1.0CM 10G,11401,HCPCS,975,RC,,,,both,345,241.5,,,,,,,,,,,,,,,,,,,Other,105.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,145.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,105.27,145.63, EXC BEN LES TAL 1.1-2.0 C 10G,11402,HCPCS,975,RC,,,,both,387,270.9,,,,,,,,,,,,,,,,,,,Other,114.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,160.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,114.52,160.86, EXC BEN LES TAL 2.1-3.0 CM 10G,11403,HCPCS,975,RC,,,,both,462,323.4,,,,,,,,,,,,,,,,,,,Other,151.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,189.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,151.52,189.13, EXC BEN LES TAL 3.1-4.0 CM 10G,11404,HCPCS,975,RC,,,,both,532,372.4,,,,,,,,,,,,,,,,,,,Other,171.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,220.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,171.92,220.33, EXC BEN LES TAL >4.0 10G,11406,HCPCS,975,RC,,,,both,789,552.3,,,,,,,,,,,,,,,,,,,Other,261.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,321.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,261.29,321.94, EXC LESION .5 OR < SNHFGEN 10G,11420,HCPCS,975,RC,,,,both,277,193.9,,,,,,,,,,,,,,,,,,,Other,84.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,116.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,84.32,116.96, EXC LESION 0.6-1.0 SNHFG G10,11421,HCPCS,975,RC,,,,both,361,252.7,,,,,,,,,,,,,,,,,,,Other,110.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,150.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,110.57,150.24, EXC LESION 1.1-2 SNHFG G10,11422,HCPCS,975,RC,,,,both,419,293.3,,,,,,,,,,,,,,,,,,,Other,138.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,169.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,138.37,169.92, EXC LESION 2.1-3.0 SNHFGEN 10G,11423,HCPCS,975,RC,,,,both,501,350.7,,,,,,,,,,,,,,,,,,,Other,160.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,198.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,160.96,198.25, EXC LES 3.1-4.0 SNHFGEN,11424,HCPCS,975,RC,,,,both,602,421.4,,,,,,,,,,,,,,,,,,,Other,186.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,232.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,186.76,232.93, EXC LESION >4.0CM SNHFGEN 10G,11426,HCPCS,975,RC,,,,both,829,580.3,,,,,,,,,,,,,,,,,,,Other,280.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,329.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,280.64,329.21, EXC LESION FEENLM <=.5CM 10G,11440,HCPCS,975,RC,,,,both,338,236.6,,,,,,,,,,,,,,,,,,,Other,106.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,132.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,106.73,132.26, EXC LESION FEENLM .6-1.0CM 10G,11441,HCPCS,975,RC,,,,both,413,289.1,,,,,,,,,,,,,,,,,,,Other,133.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,163.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,133.26,163.69, EXC LES FEENLMM 1.1-2.0 10G,11442,HCPCS,975,RC,,,,both,464,324.8,,,,,,,,,,,,,,,,,,,Other,146.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,183.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,146.8,183.24, EXC LESION FEENLM 2.1-3.0 10G,11443,HCPCS,975,RC,,,,both,576,403.2,,,,,,,,,,,,,,,,,,,Other,178.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,218.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,178.74,218.78, EXC LESION FACIAL BENIGN 3.1-4 10G,11444,HCPCS,975,RC,,,,both,674,471.8,,,,,,,,,,,,,,,,,,,Other,226.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,275.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,226.58,275.91, EXCIS BEN LESION OVER 4.0 CM,11446,HCPCS,975,RC,,,,both,1071,749.7,,,,,,,,,,,,,,,,,,,Other,322.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,384.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,322.71,384.33, EXCISION AXILLA HYDRADENITIS,11450,HCPCS,975,RC,,,,both,1136,795.2,,,,,,,,,,,,,,,,,,,Other,290.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,436.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,290.12,436.97, EXCISION HIDRADENITIS AXILL COMPLEX,11451,HCPCS,975,RC,,,,both,1456,1019.2,,,,,,,,,,,,,,,,,,,Other,367.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,547.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,367.86,547.3, EXC SKIN SUBCUT TISSIUE HIDRAENITIS 90G,11462,HCPCS,975,RC,,,,both,1247,872.9,,,,,,,,,,,,,,,,,,,Other,275.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,424.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,275.12,424.21, EXC SKIN HIDRADENITIS PERIANAL 90,11470,HCPCS,975,RC,,,,both,1240,868,,,,,,,,,,,,,,,,,,,Other,320.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,475.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,320.31,475.78, HIDRADEN EXC REPAIR COMPLES,11471,HCPCS,975,RC,,,,both,1480,1036,,,,,,,,,,,,,,,,,,,Other,379.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,557.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,379.41,557.04, EXC MAL LES TAL <=0.5CM 10G,11600,HCPCS,975,RC,,,,both,440,308,,,,,,,,,,,,,,,,,,,Other,122.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,186.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,122.04,186.51, EXC MAL LES TAL .6-1.0CM 10G,11601,HCPCS,975,RC,,,,both,500,350,,,,,,,,,,,,,,,,,,,Other,144.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,214.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,144.46,214.08, EXC MAL LES TAL 1.1-2.0 10G,11602,HCPCS,975,RC,,,,both,552,386.4,,,,,,,,,,,,,,,,,,,Other,153.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,226.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,153.43,226.36, EXC MAL LES TAL 2.1-3.0 10G,11603,HCPCS,975,RC,,,,both,648,453.6,,,,,,,,,,,,,,,,,,,Other,185.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,262,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,185.14,262, EXC MAL LES TAL 3.1-4.0 10G,11604,HCPCS,975,RC,,,,both,732,512.4,,,,,,,,,,,,,,,,,,,Other,206.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,295.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,206.18,295.54, EXC MAL LES TAL >4.0 TAL,11606,HCPCS,975,RC,,,,both,1085,759.5,,,,,,,,,,,,,,,,,,,Other,319.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,446.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,319.76,446.61, EXC MAL LES SNHFGEN <=0.5CM 10G,11620,HCPCS,975,RC,,,,both,477,333.9,,,,,,,,,,,,,,,,,,,Other,122.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,186.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,122.76,186.84, EXC MAL LES SNHFGEN 0.6-1.0 10G,11621,HCPCS,975,RC,,,,both,516,361.2,,,,,,,,,,,,,,,,,,,Other,145.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,215.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,145.53,215.31, EXC MAL LES SNHFGEN 1.1-2.0 10G,11622,HCPCS,975,RC,,,,both,585,409.5,,,,,,,,,,,,,,,,,,,Other,162.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,235.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,162.19,235.77, EXC MAL LES SNHFGEN 2.1-3.1CM 10G,11623,HCPCS,975,RC,,,,both,697,487.9,,,,,,,,,,,,,,,,,,,Other,202.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,280.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,202.06,280.9, EXC MAL LES SNHFGEN 3.1-4 10G,11624,HCPCS,975,RC,,,,both,856,599.2,,,,,,,,,,,,,,,,,,,Other,232.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,323.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,232.26,323.9, EXC MAL LES SNHFGEN >4 10G,11626,HCPCS,975,RC,,,,both,1036,725.2,,,,,,,,,,,,,,,,,,,Other,294.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,404.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,294.83,404.01, EXC MAL LES FEENL <=0.5CM G10,11640,HCPCS,975,RC,,,,both,472,330.4,,,,,,,,,,,,,,,,,,,Other,124.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,190,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,124.33,190, EXC MAL LES FEEML 0.6-1.0 10G,11641,HCPCS,975,RC,,,,both,560,392,,,,,,,,,,,,,,,,,,,Other,151.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,223.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,151.81,223.75, EXC MAL LES FEENL 1.1-2.0C 10G,11642,HCPCS,975,RC,,,,both,670,469,,,,,,,,,,,,,,,,,,,Other,174.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,252.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,174.82,252.43, EXC MAL LES FEENL 2.1-3.0 10G,11643,HCPCS,975,RC,,,,both,790,553,,,,,,,,,,,,,,,,,,,Other,220.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,301.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,220.42,301.35, EXD MAL LES FEENL 3.1-4.0 10G,11644,HCPCS,975,RC,,,,both,991,693.7,,,,,,,,,,,,,,,,,,,Other,275.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,376.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,275.06,376.05, EXC MAL LES FEENL >4.0 CM 10G,11646,HCPCS,975,RC,,,,both,1370,959,,,,,,,,,,,,,,,,,,,Other,385.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,498.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,385.88,498.71, PARING TRIMMING OF NAIL,11719,HCPCS,975,RC,,,,both,45,31.5,,,,,,,,,,,,,,,,,,,Other,7.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.67,13.54, DEBRIDE NAILS,11720,HCPCS,975,RC,,,,both,68,47.6,,,,,,,,,,,,,,,,,,,Other,14.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.81,30.81, AVULSION NAIL PLATE 00G,11730,HCPCS,975,RC,,,,both,214,149.8,,,,,,,,,,,,,,,,,,,Other,55.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,55.47,104.42, NAIL PLATE AVULSIION EACH ADDTL,11732,HCPCS,975,RC,,,,both,104,72.8,,,,,,,,,,,,,,,,,,,Other,17.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.41,30.68, EVACUATION OF SUBUNGUAL HEMATOMA,11740,HCPCS,975,RC,,,,both,115,80.5,,,,,,,,,,,,,,,,,,,Other,34.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,53.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.21,53.07, EXCISION NAIL/MATRIX 10G,11750,HCPCS,975,RC,,,,both,462,323.4,,,,,,,,,,,,,,,,,,,Other,105.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,148.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,105.39,148.42, BIOPSY OF NAIL UNIT ANY METHOD,11755,HCPCS,975,RC,,,,both,270,189,,,,,,,,,,,,,,,,,,,Other,62.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,112.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,62.71,112.81, REPAIR OF NAIL BED,11760,HCPCS,975,RC,,,,both,569,398.3,,,,,,,,,,,,,,,,,,,Other,116.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,175.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,116.74,175.63, WEDGE EXCI SKIN INGROWN TOE 10G,11765,HCPCS,975,RC,,,,both,322,225.4,,,,,,,,,,,,,,,,,,,Other,97.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,151.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,97.85,151.15, EXCISION PILONIDAL CYST SIMPLE,11770,HCPCS,975,RC,,,,both,832,582.4,,,,,,,,,,,,,,,,,,,Other,209.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,369.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,209.68,369.41, EXCISION PILONIDAL ABSCESS EXT--90,11771,HCPCS,975,RC,,,,both,1574,1101.8,,,,,,,,,,,,,,,,,,,Other,509.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,613.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,509.13,613.16, EXC PILONIDAL CYST COMPLICATED 90,11772,HCPCS,975,RC,,,,both,2044,1430.8,,,,,,,,,,,,,,,,,,,Other,655.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,814.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,655.17,814.77, INJECTION LESIONS 1-7 00G,11900,HCPCS,975,RC,,,,both,138,96.6,,,,,,,,,,,,,,,,,,,Other,27.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,53.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.64,53.32, REMOVAL CONTRACEPTIVE DEVICE/CAPSUL,11976,HCPCS,975,RC,,,,both,444,310.8,,,,,,,,,,,,,,,,,,,Other,95.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,142.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,95.52,142.53, INSERTION DRUG DELIVERY IMPLANT,11981,HCPCS,975,RC,,,,both,435,304.5,,,,,,,,,,,,,,,,,,,Other,65.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,103.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.14,103.86, REMOVAL NON-BIODEGRADABLE DRUG DELIVERY,11982,HCPCS,975,RC,,,,both,484,338.8,,,,,,,,,,,,,,,,,,,Other,74.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,111.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,74.88,111.13, SIMPLE CLOSURE SNAXGENTREX <2.6 10,12001,HCPCS,975,RC,,,,both,463,324.1,,,,,,,,,,,,,,,,,,,Other,52.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,108.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,52.45,108.07, PRI/CLOSE SNAXGENTREX 2.6-7.5,12002,HCPCS,975,RC,,,,both,556,389.2,,,,,,,,,,,,,,,,,,,Other,68.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,132.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,68.62,132.89, SIMPLE CLOSURE SANXGENTREX 7.6-12.5,12004,HCPCS,975,RC,,,,both,710,497,,,,,,,,,,,,,,,,,,,Other,86.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,155.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,86.9,155.95, SIMPLE CLOSURE SNAXGENTREX 12.6-20,12005,HCPCS,975,RC,,,,both,862,603.4,,,,,,,,,,,,,,,,,,,Other,109.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,203.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,109.26,203.49, SIMPLE REPAIR SNAXGENTREX 20.1-30,12006,HCPCS,975,RC,,,,both,990,693,,,,,,,,,,,,,,,,,,,Other,132.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,213.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,132.49,213.18, SIMPLE REPAIR SNAXGENTREX >30.0CM,12007,HCPCS,975,RC,,,,both,1076,753.2,,,,,,,,,,,,,,,,,,,Other,162.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,250.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,162.26,250.17, SIMPLE REPAIR FEENLM =15 10G,17111,HCPCS,975,RC,,,,both,309,216.3,,,,,,,,,,,,,,,,,,,Other,81.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,120.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,81.02,120.66, CHEMICAL CAUTERIZATION GRANU TISS,17250,HCPCS,975,RC,,,,both,225,157.5,,,,,,,,,,,,,,,,,,,Other,39.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,83.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,39.75,83.57, DESTRUCTION MALIGNANT LESION .6 - 1.0; S,17271,HCPCS,975,RC,,,,both,364,254.8,,,,,,,,,,,,,,,,,,,Other,100.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,152.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,100.35,152.7, DERMASENSOR,17999,HCPCS,960,RC,,,,both,350,245,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, BREAST CYST ASPIRATION 00G,19000,HCPCS,975,RC,,,,both,375,262.5,,,,,,,,,,,,,,,,,,,Other,42.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,90.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,42.84,90.75, BREAST CYST EACH ADDITIONAL,19001,HCPCS,975,RC,,,,both,120,84,,,,,,,,,,,,,,,,,,,Other,21.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,25.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,21.12,25.84, I/D W/EXPL/DRAIN ABSCESS BRST DEEP 90G,19020,HCPCS,975,RC,,,,both,1451,1015.7,,,,,,,,,,,,,,,,,,,Other,360.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,490.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,360.19,490.43, BX BREAST W/DEVICE 1ST LESION STEREOTACT,19081,HCPCS,975,RC,,,,both,2575,1802.5,,,,,,,,,,,,,,,,,,,Other,161.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,444.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,161.37,444.55, BX BREAST ADDITIONAL LESION INCLUDING ST,19082,HCPCS,975,RC,,,,both,1997,1397.9,,,,,,,,,,,,,,,,,,,Other,80.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,333.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,80.92,333.36, BREAST BX CORE W/US,19083,HCPCS,975,RC,,,,both,2485,1739.5,,,,,,,,,,,,,,,,,,,Other,152.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,441.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,152.59,441.4, BIOPSY BREAST; EACH ADDNL LESION INCLUDI,19084,HCPCS,975,RC,,,,both,2043,1430.1,,,,,,,,,,,,,,,,,,,Other,75.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,327.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,75.88,327.48, NEEDLE CORE BIOPSY BREAST,19100,HCPCS,975,RC,,,,both,477,333.9,,,,,,,,,,,,,,,,,,,Other,74.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,156.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,74.98,156.06, INCISIONAL BREAST BIOPSY 10,19101,HCPCS,975,RC,,,,both,1016,711.2,,,,,,,,,,,,,,,,,,,Other,252.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,339.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,252.35,339.28, NIPPLE EXPLO W/WO EXCIS OF SOL LACT,19110,HCPCS,975,RC,,,,both,1412,988.4,,,,,,,,,,,,,,,,,,,Other,407.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,514.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,407.85,514.54, BREAST BIOPSY EXCISIONAL 90G,19120,HCPCS,975,RC,,,,both,1465,1025.5,,,,,,,,,,,,,,,,,,,Other,474.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,560.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,474.01,560.11, EXCISION BREAST LEASION W PRE-OP RAD MAR,19125,HCPCS,975,RC,,,,both,1690,1183,,,,,,,,,,,,,,,,,,,Other,528.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,622.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,528.14,622.43, EXCISION ADDITIONAL BREAST LESION,19126,HCPCS,975,RC,,,,both,668,467.6,,,,,,,,,,,,,,,,,,,Other,175.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,152.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,152.48,175.35, PERQ DEVICE PLACEMENT BREAST LOC 1ST LS,19281,HCPCS,975,RC,,,,both,683,478.1,,,,,,,,,,,,,,,,,,,Other,96.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,219.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,96.61,219.69, PLACEMENT OF BREAST LOCALIZATION DEVICE,19283,HCPCS,975,RC,,,,both,650,455,,,,,,,,,,,,,,,,,,,Other,98.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,233.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,98.13,233.86, BREAST NEELE LOC,19285,HCPCS,975,RC,,,,both,611,427.7,,,,,,,,,,,,,,,,,,,Other,83.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,322.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,83.74,322.05, "ASST BREAST NEEDLE PLACEMENT,ASSISTANT SURGEON",19285,HCPCS,975,RC,80,,,both,153,107.1,,,,,,,,,,,,,,,,,,,Other,13.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,51.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.4,51.53, MASTECTOMY SUB-Q FOR GYNECOMASTIA,19300,HCPCS,975,RC,,,,both,1714,1199.8,,,,,,,,,,,,,,,,,,,Other,484.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,610.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,484.76,610.71, MASTECTOMY PARTIAL/LUMPECTOMY 90G,19301,HCPCS,975,RC,,,,both,2209,1546.3,,,,,,,,,,,,,,,,,,,Other,745.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,648.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,648.2,745.43, MASTECTOMY PARTIAL W/LYMPH 90G,19302,HCPCS,975,RC,,,,both,3142,2199.4,,,,,,,,,,,,,,,,,,,Other,1023.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,889.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,889.64,1023.09, MASTECTOMY SIMPLE COMPLETE 90G,19303,HCPCS,975,RC,,,,both,3501,2450.7,,,,,,,,,,,,,,,,,,,Other,1082.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,940.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,940.9,1082.04, "ASST MASTECTOMY SIMPLE LUMPECTOMY,ASSISTANT SURGEON",19301,HCPCS,975,RC,80,,,both,552,386.4,,,,,,,,,,,,,,,,,,,Other,119.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,103.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,103.71,119.27, "ASST MASTECTOMY PARTIAL W/LYMPHADENECTOM,ASSISTANT SURGEON",19302,HCPCS,975,RC,80,,,both,786,550.2,,,,,,,,,,,,,,,,,,,Other,163.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,142.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,142.34,163.7, MOD RAD MASTECTOMY 90G,19307,HCPCS,975,RC,,,,both,4099,2869.3,,,,,,,,,,,,,,,,,,,Other,1327.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1154.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1154.36,1327.52, "ASST MASTECTOMY SIMPLE COMPLETE,ASSISTANT SURGEON",19303,HCPCS,975,RC,80,,,both,876,613.2,,,,,,,,,,,,,,,,,,,Other,173.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,150.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,150.55,173.13, "ASST MODIFIED RADICAL MASTECTOMY,ASSISTANT SURGEON",19307,HCPCS,975,RC,80,,,both,1025,717.5,,,,,,,,,,,,,,,,,,,Other,212.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,184.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,184.7,212.41, REMOVAL OF INTACT BREAST IMPLANT,19328,HCPCS,975,RC,,,,both,2029,1420.3,,,,,,,,,,,,,,,,,,,Other,586.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,509.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,509.77,586.24, ABD WOUND TRAUMA EXPL/REPAIR,20102,HCPCS,975,RC,,,,both,1578,1104.6,,,,,,,,,,,,,,,,,,,Other,289.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,624.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,289.19,624.44, EXPLOR OF PENETRAT WOUND; EXTREMITY,20103,HCPCS,975,RC,,,,both,1972,1380.4,,,,,,,,,,,,,,,,,,,Other,368.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,566.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,368.07,566.62, DEEP MUSCLE BIOPSY,20205,HCPCS,975,RC,,,,both,974,681.8,,,,,,,,,,,,,,,,,,,Other,174.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,323.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,174.62,323.39, BIOPSY SOFT TISSUE NEEDLE,20206,HCPCS,975,RC,,,,both,489,342.3,,,,,,,,,,,,,,,,,,,Other,58.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,192.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,58.45,192.79, BX BONE TROCAR NEEDLE SUPERFIC,20220,HCPCS,975,RC,,,,both,569,398.3,,,,,,,,,,,,,,,,,,,Other,88.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,207.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,88.13,207.84, BX BONE DEEP,20225,HCPCS,975,RC,,,,both,1074,751.8,,,,,,,,,,,,,,,,,,,Other,130.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,338.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,130.7,338.69, BIOPSY EXCIS;SUPERFIC/RIB ILIUM FEM,20240,HCPCS,975,RC,,,,both,703,492.1,,,,,,,,,,,,,,,,,,,Other,145.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,126.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,126.88,145.91, SINOGRAM,20501,HCPCS,975,RC,,,,both,291,203.7,,,,,,,,,,,,,,,,,,,Other,36.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,124.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.09,124.93, REMOVE FB MUSCLE TENDON SHEATH,20520,HCPCS,975,RC,,,,both,592,414.4,,,,,,,,,,,,,,,,,,,Other,158.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,216.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,158.73,216.62, FB EXCISION DEEP/COMPLICATED G10,20525,HCPCS,975,RC,,,,both,1336,935.2,,,,,,,,,,,,,,,,,,,Other,267.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,468.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,267.33,468.56, THERAPEUTIC INJ FOR CARPAL TUNNEL,20526,HCPCS,975,RC,,,,both,267,186.9,,,,,,,,,,,,,,,,,,,Other,58.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,85.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,58.05,85.13, TRIGGER PNT INJ TEND LIG 00G,20550,HCPCS,975,RC,,,,both,186,130.2,,,,,,,,,,,,,,,,,,,Other,38.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,58.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,38.96,58.08, INJECTION SINGLE TENDON ORIG/INSERT,20551,HCPCS,975,RC,,,,both,184,128.8,,,,,,,,,,,,,,,,,,,Other,38.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,57.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,38.38,57.87, TRIGGER PT INJ 1 OR 2 MUSC GRPS,20552,HCPCS,975,RC,,,,both,197,137.9,,,,,,,,,,,,,,,,,,,Other,40.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,49.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,40.58,49.64, TRIGGER PT INJ 3 OR MORE MUSC GRPS,20553,HCPCS,975,RC,,,,both,255,178.5,,,,,,,,,,,,,,,,,,,Other,46.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,57.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,46.28,57.27, INJECT ASPIRAT ARTHOCENT SMALL JNT,20600,HCPCS,975,RC,,,,both,163,114.1,,,,,,,,,,,,,,,,,,,Other,36.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,53.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.36,53.73, INTERMED JOINT BURSA GANG CYST,20605,HCPCS,975,RC,,,,both,189,132.3,,,,,,,,,,,,,,,,,,,Other,37.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,54.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,37.11,54.68, JOINT INJECTION LARGE,20610,HCPCS,975,RC,,,,both,249,174.3,,,,,,,,,,,,,,,,,,,Other,46.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,66.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,46.6,66.52, ARTHRO ASPIR/INJ LG JNT W/US,20611,HCPCS,975,RC,,,,both,381,266.7,,,,,,,,,,,,,,,,,,,Other,58.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,99.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,58.48,99.26, ASP/INJ GANGLION CYST 00,20612,HCPCS,975,RC,,,,both,188,131.6,,,,,,,,,,,,,,,,,,,Other,42.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,64.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,42.23,64.51, ASP/INJ TRMT BONE CYST 10G,20615,HCPCS,975,RC,,,,both,654,457.8,,,,,,,,,,,,,,,,,,,Other,162.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,235.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,162.01,235.02, REMOVE IMPLANT DEEP 90G,20680,HCPCS,975,RC,,,,both,1854,1297.8,,,,,,,,,,,,,,,,,,,Other,450.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,604.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,450.85,604.52, "ASST REMOVE IMPLANT DEEP 90G,ASSISTANT PRACTITIONER",20680,HCPCS,975,RC,AS,,,both,464,324.8,,,,,,,,,,,,,,,,,,,Other,72.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,96.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.14,96.73, ALLOGRAFT MORSELIZED/PLLCMT OF OSTEOPROM,20930,HCPCS,960,RC,,,,both,872,610.4,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ALLOGRAFT STRUCTURAL SPINE SURGERY ONLY,20931,HCPCS,975,RC,,,,both,706,494.2,,,,,,,,,,,,,,,,,,,Other,121.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,105.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,105.43,121.25, AUTOGRAFT FOR SPINE SURGERY ONLY,20936,HCPCS,975,RC,,,,both,1177,823.9,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, AUTOGRAFT MORSELIZED FOR SPINE SURGERY O,20937,HCPCS,975,RC,,,,both,1284,898.8,,,,,,,,,,,,,,,,,,,Other,179.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,156.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,156.35,179.8, COMPARTMENT PRESSURES,20950,HCPCS,975,RC,,,,both,760,532,,,,,,,,,,,,,,,,,,,Other,95.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,257.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,95.33,257.12, EXC MASS SUBQ<2CM FACE/SCALP 90G,21011,HCPCS,975,RC,,,,both,1019,713.3,,,,,,,,,,,,,,,,,,,Other,279.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,373.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,279.95,373.14, EXC MASS SUBQ >2CM FACE/SCALP 90G,21012,HCPCS,975,RC,,,,both,1044,730.8,,,,,,,,,,,,,,,,,,,Other,369.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,321.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,321.61,369.85, CLOSED TRMT NASAL SEPTUM FRACTURE,21337,HCPCS,975,RC,,,,both,1379,965.3,,,,,,,,,,,,,,,,,,,Other,313.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,401.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,313.14,401.7, I&D ABSCESS HEMATOMA NECK THORAX 90,21501,HCPCS,975,RC,,,,both,1502,1051.4,,,,,,,,,,,,,,,,,,,Other,370.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,491.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,370.17,491.93, EXC BX SOFT TISS NECK/THORAX G10,21550,HCPCS,975,RC,,,,both,751,525.7,,,,,,,,,,,,,,,,,,,Other,161.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,255.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,161.87,255.52, EXC SOFT TISSUE MASS NECK/THORAX>3 90G,21552,HCPCS,975,RC,,,,both,1457,1019.9,,,,,,,,,,,,,,,,,,,Other,499.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,433.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,433.96,499.06, EXC NECK THORAX MASS >5CM 90,21554,HCPCS,975,RC,,,,both,2473,1731.1,,,,,,,,,,,,,,,,,,,Other,794.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,690.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,690.81,794.44, EXCISION TUMOR NECK OR THORAX <3CM 90G,21555,HCPCS,975,RC,,,,both,1262,883.4,,,,,,,,,,,,,,,,,,,Other,338.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,442.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,338.92,442.35, EXCISION TUMOR SUBCU 90G,21556,HCPCS,975,RC,,,,both,1713,1199.1,,,,,,,,,,,,,,,,,,,Other,566.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,492.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,492.37,566.22, RESECT 1ST RIB SCALENECTOMY,21615,HCPCS,975,RC,,,,both,2953,2067.1,,,,,,,,,,,,,,,,,,,Other,694.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,604.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,604.26,694.9, SCALENOTOMY,21700,HCPCS,975,RC,,,,both,1626,1138.2,,,,,,,,,,,,,,,,,,,Other,400.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,348.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,348.27,400.52, "ASST SCALENOTOMY,ASSISTANT SURGEON",21700,HCPCS,975,RC,80,,,both,407,284.9,,,,,,,,,,,,,,,,,,,Other,64.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,55.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,55.72,64.08, FX TRMT STERNUM CLOSED,21820,HCPCS,975,RC,,,,both,752,526.4,,,,,,,,,,,,,,,,,,,Other,185.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,170.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,170.74,185.36, EXC BX LESION BACK FLANK 10G,21920,HCPCS,975,RC,,,,both,569,398.3,,,,,,,,,,,,,,,,,,,Other,160.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,248.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,160.49,248.34, EXCISION BIOPSY DEEP BACK OR FLANK,21925,HCPCS,975,RC,,,,both,1353,947.1,,,,,,,,,,,,,,,,,,,Other,423.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,520.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,423.52,520.69, EX TUMOR SOFT TIS BACK OR FLANK,21930,HCPCS,975,RC,,,,both,1437,1005.9,,,,,,,,,,,,,,,,,,,Other,403.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,520.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,403.52,520.33, EXC SOFT TISS TUMOR BACK FLANK 90,21931,HCPCS,975,RC,,,,both,1464,1024.8,,,,,,,,,,,,,,,,,,,Other,529.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,460.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,460.27,529.31, EXC MASS TUMOR SUB-FASCIAL BACK 90G,21932,HCPCS,975,RC,,,,both,2131,1491.7,,,,,,,,,,,,,,,,,,,Other,731.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,636.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,636.36,731.82, EXC TUMOR SUBFASCIAL BK/FLNK 5CM+ 90G,21933,HCPCS,975,RC,,,,both,2439,1707.3,,,,,,,,,,,,,,,,,,,Other,820.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,713.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,713.46,820.48, "ASST EXC SOFT TISS TUMOR BACK FLANK 90,ASSISTANT SURGEON",21931,HCPCS,975,RC,80,,,both,366,256.2,,,,,,,,,,,,,,,,,,,Other,84.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,73.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,73.65,84.69, RADICAL EXCISION RESECTION OF TUMOR,21935,HCPCS,975,RC,,,,both,3637,2545.9,,,,,,,,,,,,,,,,,,,Other,1122.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,975.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,975.78,1122.14, INCISION & DRAINAGE OF DEEP SPINAL ABSCE,22015,HCPCS,975,RC,,,,both,3701,2590.7,,,,,,,,,,,,,,,,,,,Other,1077.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,936.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,936.94,1077.48, PERCUTANEOUS VERTEBRAL AUGMENTATION THOR,22513,HCPCS,975,RC,,,,both,2969,2078.3,,,,,,,,,,,,,,,,,,,Other,532.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2909.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,532.74,2909.62, PERCUTANEOUS VERTEBRAL AUGMENTATION; LUM,22514,HCPCS,975,RC,,,,both,2585,1809.5,,,,,,,,,,,,,,,,,,,Other,497.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2533.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,497.22,2533.3, PERCUTANEOUS VERTEBRAL AUGMNTN; LUMBAR E,22515,HCPCS,975,RC,,,,both,1273,891.1,,,,,,,,,,,,,,,,,,,Other,226.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1247.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,226.62,1247.54, ARTHRODESIS DISCECTOMY DECOMPRS; BELOW C,22551,HCPCS,975,RC,,,,both,8664,6064.8,,,,,,,,,,,,,,,,,,,Other,1932.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1680.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1680.73,1932.83, "ASST ARTHRODESIS DISCECTOMY DECOMPRS; BE,ASSISTANT SURGEON",22551,HCPCS,975,RC,80,,,both,2166,1516.2,,,,,,,,,,,,,,,,,,,Other,309.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,268.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,268.91,309.26, ARTHRODESIS DISCECTOMY & DECOMPRSN; BELO,22552,HCPCS,975,RC,,,,both,2338,1636.6,,,,,,,,,,,,,,,,,,,Other,435.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,378.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,378.62,435.41, "ASST (PA) ARTHORDESIS DISCECTOMY DECOMPR,ASSISTANT PRACTITIONER",22551,HCPCS,975,RC,AS,,,both,2166,1516.2,,,,,,,,,,,,,,,,,,,Other,309.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,268.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,268.91,309.26, ARTHRODESIS ANTERIOR INTERBODY TECH CERV,22554,HCPCS,975,RC,,,,both,6465,4525.5,,,,,,,,,,,,,,,,,,,Other,1449.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1260.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1260.86,1449.99, "ASST ARTHRODESIS DISCECTOMY & DCMPRSN; B,ASSISTANT SURGEON",22552,HCPCS,975,RC,80,,,both,585,409.5,,,,,,,,,,,,,,,,,,,Other,69.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,60.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.58,69.67, "ASST (PA) ARTHRODESIS DISCECTOMY & DCMPR,ASSISTANT PRACTITIONER",22552,HCPCS,975,RC,AS,,,both,585,409.5,,,,,,,,,,,,,,,,,,,Other,69.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,60.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.58,69.67, "ASST ARTHRODESIS ANTERIOR INTERBODY TECH,ASSISTANT SURGEON",22554,HCPCS,975,RC,80,,,both,1616,1131.2,,,,,,,,,,,,,,,,,,,Other,232,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,201.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,201.73,232, ARTHRODESIS ANTERIOR DISCECTOMY TO PREPA,22558,HCPCS,975,RC,,,,both,7559,5291.3,,,,,,,,,,,,,,,,,,,Other,1699.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1477.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1477.42,1699.04, "ASST ARTHRODESIS ANTERIOR INTERBODY TECH,ASSISTANT PRACTITIONER",22554,HCPCS,975,RC,AS,,,both,1616,1131.2,,,,,,,,,,,,,,,,,,,Other,232,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,201.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,201.73,232, "ARTHRODESIS ANTERIOR DISCECTOMY TO PREPA,ASSISTANT SURGEON",22558,HCPCS,975,RC,80,,,both,1890,1323,,,,,,,,,,,,,,,,,,,Other,271.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,236.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,236.39,271.84, ARTHRODESIS EACH ADDNL INTERSPACE,22585,HCPCS,975,RC,,,,both,1939,1357.3,,,,,,,,,,,,,,,,,,,Other,352.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,306.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,306.89,352.92, "ARTHRODESIS EACH ADDNL INTERSPACE,ASSISTANT PRACTITIONER",22585,HCPCS,975,RC,AS,,,both,485,339.5,,,,,,,,,,,,,,,,,,,Other,56.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,49.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,49.1,56.47, ARTHROSESIS SINGLE INTERSPACE (CERVICAL,22600,HCPCS,975,RC,,,,both,6640,4648,,,,,,,,,,,,,,,,,,,Other,1524.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1325.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1325.36,1524.16, "ARTHROSESIS SINGLE INTERSPACE (CERVICAL,ASSISTANT PRACTITIONER",22600,HCPCS,975,RC,AS,,,both,1660,1162,,,,,,,,,,,,,,,,,,,Other,243.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,212.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,212.06,243.86, ARTHRODESIS; POSTRR OR POSTEROLATERAL TE,22612,HCPCS,975,RC,,,,both,7942,5559.4,,,,,,,,,,,,,,,,,,,Other,1747.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1519.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1519.33,1747.23, "ASST ARTHRODESIS; POSTRR/POSTEROLATERAL,ASSISTANT PRACTITIONER",22612,HCPCS,975,RC,AS,,,both,1986,1390.2,,,,,,,,,,,,,,,,,,,Other,279.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,243.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,243.09,279.55, ARTHRODESIS SINGLE LEVEL EACH ADDNL VERT,22614,HCPCS,975,RC,,,,both,2175,1522.5,,,,,,,,,,,,,,,,,,,Other,430.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,374.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,374.71,430.92, "ASST ARTHRODESIS SINGLE LEVEL EACH ADDNL,ASSISTANT SURGEON",22614,HCPCS,975,RC,80,,,both,544,380.8,,,,,,,,,,,,,,,,,,,Other,68.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,59.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,59.96,68.94, "ASST ARTHRODESIS SINGLE LEVEL EACH ADDNL,ASSISTANT PRACTITIONER",22614,HCPCS,975,RC,AS,,,both,544,380.8,,,,,,,,,,,,,,,,,,,Other,68.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,59.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,59.96,68.94, ARTHRODESIS POSTERIOR TECH LAMINECTOMY S,22630,HCPCS,975,RC,,,,both,7286,5100.2,,,,,,,,,,,,,,,,,,,Other,1817.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1580.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1580.7,1817.8, "ASST ARTHRODESIS POSTERIOR TECH LAMINECT,ASSISTANT SURGEON",22630,HCPCS,975,RC,80,,,both,1822,1275.4,,,,,,,,,,,,,,,,,,,Other,290.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,252.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,252.91,290.84, ARTHRODESIS PSTRIOR LAMINECTOMY LUMBAR E,22632,HCPCS,975,RC,,,,both,1841,1288.7,,,,,,,,,,,,,,,,,,,Other,356.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,309.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,309.9,356.38, ARTHRODESIS INCLUDING LAMENECTOMY SINGLE,22633,HCPCS,975,RC,,,,both,9371,6559.7,,,,,,,,,,,,,,,,,,,Other,2041.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1775.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1775.56,2041.9, ARTHRODESIS EACH ADDNL SPACE,22634,HCPCS,975,RC,,,,both,2772,1940.4,,,,,,,,,,,,,,,,,,,Other,533.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,464,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,464,533.6, "ASST ARTHRODESIS POSTERIOR TECH LANIMECT,ASSISTANT PRACTITIONER",22630,HCPCS,975,RC,AS,,,both,1822,1275.4,,,,,,,,,,,,,,,,,,,Other,290.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,252.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,252.91,290.84, "ASST ARTHRODESIS PSTRIOR LAMINECTMY LMBA,ASSISTANT PRACTITIONER",22632,HCPCS,975,RC,AS,,,both,460,322,,,,,,,,,,,,,,,,,,,Other,57.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,49.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,49.59,57.02, "ASST ARTHRODESIS INCLUDING LAMENECTOMY S,ASSISTANT SURGEON",22633,HCPCS,975,RC,80,,,both,2343,1640.1,,,,,,,,,,,,,,,,,,,Other,326.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,284.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,284.09,326.7, "ASST ARTHRODESIS INCLUDING LAMENECTOMY S,ASSISTANT PRACTITIONER",22633,HCPCS,975,RC,AS,,,both,2343,1640.1,,,,,,,,,,,,,,,,,,,Other,326.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,284.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,284.09,326.7, "ASST ARTHRODESIS EACH ADDITIONAL SPACE,ASSISTANT SURGEON",22634,HCPCS,975,RC,80,,,both,693,485.1,,,,,,,,,,,,,,,,,,,Other,85.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,74.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,74.24,85.38, "ASST ARTHRODESIS EACH ADDITIONAL SPACE,ASSISTANT PRACTITIONER",22634,HCPCS,975,RC,AS,,,both,693,485.1,,,,,,,,,,,,,,,,,,,Other,85.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,74.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,74.24,85.38, EXPLORATION OF SPINAL FUSION,22830,HCPCS,975,RC,,,,both,5002,3501.4,,,,,,,,,,,,,,,,,,,Other,932.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,810.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,810.5,932.08, "ASST EXPLORATION OF SPINAL FUSION,ASSISTANT SURGEON",22830,HCPCS,975,RC,80,,,both,1251,875.7,,,,,,,,,,,,,,,,,,,Other,149.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,129.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,129.68,149.14, POSTERIOR NON-SEGMENTAL INSTRUMENTATION,22840,HCPCS,975,RC,,,,both,4970,3479,,,,,,,,,,,,,,,,,,,Other,819.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,712.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,712.77,819.69, "ASST POSTERIOR NON-SEGMENTAL INTRUMENTAT,ASSISTANT SURGEON",22840,HCPCS,975,RC,80,,,both,1243,870.1,,,,,,,,,,,,,,,,,,,Other,131.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,114.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,114.04,131.15, POSTERIOR SEGMENTAL INSTRUMENTATION 3-6,22842,HCPCS,975,RC,,,,both,5515,3860.5,,,,,,,,,,,,,,,,,,,Other,837.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,728.67,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,728.67,837.97, "ASST POSTERIOR NON-SEGMENTAL INTRUMENTAT,ASSISTANT PRACTITIONER",22840,HCPCS,975,RC,AS,,,both,1243,870.1,,,,,,,,,,,,,,,,,,,Other,131.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,114.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,114.04,131.15, "ASST POSTERIOR SEGMENTAL INSTRUMENTATION,ASSISTANT SURGEON",22842,HCPCS,975,RC,80,,,both,1379,965.3,,,,,,,,,,,,,,,,,,,Other,134.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,116.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,116.59,134.07, ANTERIOR INSTRUMENTATION; 2-3 VERTEBRAL,22845,HCPCS,975,RC,,,,both,5265,3685.5,,,,,,,,,,,,,,,,,,,Other,798.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,694.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,694.54,798.72, SPINAL ANTERIOR INSTUMENTATION; 4-7 VERT,22846,HCPCS,975,RC,,,,both,5525,3867.5,,,,,,,,,,,,,,,,,,,Other,830.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,722.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,722.23,830.57, "ASST POSTERIOR SEGMENTAL INSTRUMENTATION,ASSISTANT PRACTITIONER",22842,HCPCS,975,RC,AS,,,both,1379,965.3,,,,,,,,,,,,,,,,,,,Other,134.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,116.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,116.59,134.07, "ASST ANTERIOR INTRUMENTATION; 2-3 VERTEB,ASSISTANT SURGEON",22845,HCPCS,975,RC,80,,,both,1316,921.2,,,,,,,,,,,,,,,,,,,Other,127.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,111.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,111.12,127.79, REINSERTION OF SPINAL FIXATION DEVICE,22849,HCPCS,975,RC,,,,both,6415,4490.5,,,,,,,,,,,,,,,,,,,Other,1464.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1273.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1273.88,1464.96, "ASST (PA) ANTERIOR INTRUMENTATION; 2-3 V,ASSISTANT PRACTITIONER",22845,HCPCS,975,RC,AS,,,both,1316,921.2,,,,,,,,,,,,,,,,,,,Other,127.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,111.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,111.12,127.79, "ASST (PA) SPINAL ANTERIOR INSTRUMENTATIO,ASSISTANT PRACTITIONER",22846,HCPCS,975,RC,AS,,,both,1381,966.7,,,,,,,,,,,,,,,,,,,Other,132.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,115.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,115.56,132.89, REMOVAL POSTERIOR SEGMENTAL INSTRUMENTAT,22852,HCPCS,975,RC,,,,both,3457,2419.9,,,,,,,,,,,,,,,,,,,Other,811.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,705.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,705.88,811.76, INSERT OF INTERBODY BIOMECHANICAL DEVICE,22853,HCPCS,975,RC,,,,both,1480,1036,,,,,,,,,,,,,,,,,,,Other,281.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,244.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,244.8,281.52, INSERT OF INTERVERTEVRAL BIOMECHANICAL D,22854,HCPCS,975,RC,,,,both,1882,1317.4,,,,,,,,,,,,,,,,,,,Other,371.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,323.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,323.38,371.89, "ASST REINSERTION OF SPINAL FIXATION DEVI,ASSISTANT SURGEON",22849,HCPCS,975,RC,80,,,both,1604,1122.8,,,,,,,,,,,,,,,,,,,Other,234.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,203.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,203.82,234.4, TOTAL DISC ARTHROPLASTY SINGLE INTERSPAC,22856,HCPCS,975,RC,,,,both,7815,5470.5,,,,,,,,,,,,,,,,,,,Other,1824.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1586.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1586.09,1824.01, "REINSERTION OF SPINAL FIXATION DEVICE,ASSISTANT PRACTITIONER",22849,HCPCS,975,RC,AS,,,both,1604,1122.8,,,,,,,,,,,,,,,,,,,Other,234.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,203.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,203.82,234.4, TOTAL DISC ARTHROPLASTY SECOND LEVEL CER,22858,HCPCS,975,RC,,,,both,2470,1729,,,,,,,,,,,,,,,,,,,Other,551.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,479.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,479.32,551.22, "ASST REMOVAL POSTERIOR SEGMENTAL INSTRUM,ASSISTANT PRACTITIONER",22852,HCPCS,975,RC,AS,,,both,864,604.8,,,,,,,,,,,,,,,,,,,Other,129.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,112.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,112.94,129.88, "ASST INSERT OF INTERBODY BIOMECHANICAL D,ASSISTANT SURGEON",22853,HCPCS,975,RC,80,,,both,370,259,,,,,,,,,,,,,,,,,,,Other,45.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,39.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,39.17,45.04, "ASST (PA)INSERT OF INTERBODY BIOMECHANIC,ASSISTANT PRACTITIONER",22853,HCPCS,975,RC,AS,,,both,370,259,,,,,,,,,,,,,,,,,,,Other,45.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,39.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,39.17,45.04, "ASST INSERT OF INTERVERTEBRAL BIOMECHANI,ASSISTANT PRACTITIONER",22854,HCPCS,975,RC,AS,,,both,471,329.7,,,,,,,,,,,,,,,,,,,Other,59.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,51.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,51.74,59.51, "ASST TOTAL DISC ARTHROPLASTY SINGLE INTE,ASSISTANT SURGEON",22856,HCPCS,975,RC,80,,,both,1954,1367.8,,,,,,,,,,,,,,,,,,,Other,291.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,253.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,253.77,291.84, "ASST TOTAL DISC ARTHROPLASTY SINGLE INTE,ASSISTANT PRACTITIONER",22856,HCPCS,975,RC,AS,,,both,1954,1367.8,,,,,,,,,,,,,,,,,,,Other,291.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,253.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,253.77,291.84, EXCISION ABDOMINAL WALL TUMOR SUBFA 90G,22900,HCPCS,975,RC,,,,both,1778,1244.6,,,,,,,,,,,,,,,,,,,Other,638.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,555.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,555.04,638.3, EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUB,22901,HCPCS,975,RC,,,,both,2161,1512.7,,,,,,,,,,,,,,,,,,,Other,752.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,654.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,654.73,752.93, EXC TUMOR SOFT TISSUE ABD WALL SUBQ >3CM,22902,HCPCS,975,RC,,,,both,1439,1007.3,,,,,,,,,,,,,,,,,,,Other,381.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,497.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,381.23,497.96, EXC ABD WALL SQ MASS >3CM 90,22903,HCPCS,975,RC,,,,both,1475,1032.5,,,,,,,,,,,,,,,,,,,Other,499.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,434.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,434.66,499.86, "ASST EXCISION ABDOMINAL WALL TUMOR SUBFA,ASSISTANT SURGEON",22900,HCPCS,975,RC,80,,,both,445,311.5,,,,,,,,,,,,,,,,,,,Other,102.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,88.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,88.81,102.13, ABDOM TUMOR RAD RESECTION 5 CM/+ 90,22905,HCPCS,975,RC,,,,both,4673,3271.1,,,,,,,,,,,,,,,,,,,Other,1460.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1269.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1269.92,1460.42, "ASST EXC ABD WALL SQ MASS >3CM,ASSISTANT SURGEON",22903,HCPCS,975,RC,80,,,both,369,258.3,,,,,,,,,,,,,,,,,,,Other,79.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,69.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,69.54,79.98, BX SOFT TISSUE SHOULDER,23065,HCPCS,975,RC,,,,both,487,340.9,,,,,,,,,,,,,,,,,,,Other,166.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,220.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,166.78,220.93, EXCISION BIOPSY SOFT TISS OF SHOULD,23066,HCPCS,975,RC,,,,both,1760,1232,,,,,,,,,,,,,,,,,,,Other,413.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,591.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,413.25,591.25, EXC SHOULDER SOFT TISS 3CM+ 90G,23071,HCPCS,975,RC,,,,both,1364,954.8,,,,,,,,,,,,,,,,,,,Other,471.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,409.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,409.86,471.33, EXC TUMOR SHOULDER SUBFASC >5CM 90,23073,HCPCS,975,RC,,,,both,2648,1853.6,,,,,,,,,,,,,,,,,,,Other,765.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,665.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,665.76,765.62, "EXC TUMOR ON SHOULDER SUBFASCIAL >5CM AS,ASSISTANT PRACTITIONER",23073,HCPCS,975,RC,AS,,,both,662,463.4,,,,,,,,,,,,,,,,,,,Other,122.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,106.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,106.53,122.5, EXC TUMOR SHOULDER SUBCUTANEOUS <3CM 90G,23075,HCPCS,975,RC,,,,both,1231,861.7,,,,,,,,,,,,,,,,,,,Other,366.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,527.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,366.56,527.64, EXC DEEP SUBFASCIAL OR INTRAMUSCULAR <5C,23076,HCPCS,975,RC,,,,both,1951,1365.7,,,,,,,,,,,,,,,,,,,Other,602.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,523.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,523.55,602.07, CLAVICULECTOMY; PARTIAL,23120,HCPCS,975,RC,,,,both,2343,1640.1,,,,,,,,,,,,,,,,,,,Other,640.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,557.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,557.38,640.98, "CLAVICULECTOMY; PARTIAL ASSISTANT,ASSISTANT PRACTITIONER",23120,HCPCS,975,RC,AS,,,both,586,410.2,,,,,,,,,,,,,,,,,,,Other,102.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,89.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,89.18,102.56, ACRIMIOPLASTY PARTIAL WITH OR WITHOUT LI,23130,HCPCS,975,RC,,,,both,2327,1628.9,,,,,,,,,,,,,,,,,,,Other,671.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,584.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,584.08,671.69, PARTIAL EXCISION CLAVICLE,23180,HCPCS,975,RC,,,,both,2485,1739.5,,,,,,,,,,,,,,,,,,,Other,748.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,650.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,650.59,748.18, ROTATOR CUFF REPAIR CHRONIC,23412,HCPCS,975,RC,,,,both,3503,2452.1,,,,,,,,,,,,,,,,,,,Other,911.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,792.67,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,792.67,911.58, "ROTATOR CUFF REPAIR CHRONIC,ASSISTANT PRACTITIONER",23412,HCPCS,975,RC,AS,,,both,876,613.2,,,,,,,,,,,,,,,,,,,Other,145.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,126.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,126.83,145.85, RECONSTRUCTION OF ROTAOR CUFF W/ACROMIOP,23420,HCPCS,975,RC,,,,both,4002,2801.4,,,,,,,,,,,,,,,,,,,Other,1043.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,907.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,907.61,1043.75, "RECONSTRUCTION OF ROTAOR CUFF W/ACROMIOP,ASSISTANT PRACTITIONER",23420,HCPCS,975,RC,AS,,,both,1000,700,,,,,,,,,,,,,,,,,,,Other,167,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,145.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,145.22,167, TENODESIS OF LONG TENDON OF BICEP,23430,HCPCS,975,RC,,,,both,3132,2192.4,,,,,,,,,,,,,,,,,,,Other,797.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,693.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,693.69,797.75, "TENODESIS OF LONG TENDON OF BICEP ASST,ASSISTANT PRACTITIONER",23430,HCPCS,975,RC,AS,,,both,783,548.1,,,,,,,,,,,,,,,,,,,Other,127.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,110.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,110.99,127.64, CLSD TRMT CLAVICULAR FRACTURE,23500,HCPCS,975,RC,,,,both,933,653.1,,,,,,,,,,,,,,,,,,,Other,270.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,246.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,246.71,270.31, AC DISLOCATION CLSD TRMT W/O MANIP,23540,HCPCS,975,RC,,,,both,1006,704.2,,,,,,,,,,,,,,,,,,,Other,283.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,264.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,264.42,283.81, SCAPULAR FRACTURE CLOSED TREATMENT,23570,HCPCS,975,RC,,,,both,893,625.1,,,,,,,,,,,,,,,,,,,Other,279.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,254.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,254.44,279.19, CLSD TRTMNT OF PROX HUMER W/O MANIP,23600,HCPCS,975,RC,,,,both,1246,872.2,,,,,,,,,,,,,,,,,,,Other,366.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,362.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,362.32,366.14, CLOSED TRMT SHOULDER DISLOCATION,23650,HCPCS,975,RC,,,,both,1254,877.8,,,,,,,,,,,,,,,,,,,Other,409.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,415.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,409.72,415.45, CLSD TRMT SHOULDER DISLOC W MAN ANE 90G,23655,HCPCS,975,RC,,,,both,1642,1149.4,,,,,,,,,,,,,,,,,,,Other,471.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,409.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,409.68,471.14, ID UPPER ARM/ELBOW DEEP ABSCESS,23930,HCPCS,975,RC,,,,both,1101,770.7,,,,,,,,,,,,,,,,,,,Other,235.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,362.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,235.51,362.29, ID ARM/ELBOW INFECTED BURSA,23931,HCPCS,975,RC,,,,both,906,634.2,,,,,,,,,,,,,,,,,,,Other,177.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,302.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,177.67,302.43, BX SOFT TISSUE UPPER ARM ELBOW G10,24065,HCPCS,975,RC,,,,both,662,463.4,,,,,,,,,,,,,,,,,,,Other,166.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,246.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,166.6,246.48, BX UPPER ARM DEEP SOFT TISSUE 90,24066,HCPCS,975,RC,,,,both,1855,1298.5,,,,,,,,,,,,,,,,,,,Other,474.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,654.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,474.33,654.53, EXC ARM ELBOW SOFT TISSUE TUMOR 3MC OR >,24071,HCPCS,975,RC,,,,both,1369,958.3,,,,,,,,,,,,,,,,,,,Other,453.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,394.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,394.25,453.4, "EXC ARM ELBOW SOFT TISSUE TUMOR 3MC OR >,ASSISTANT PRACTITIONER",24071,HCPCS,975,RC,AS,,,both,342,239.4,,,,,,,,,,,,,,,,,,,Other,72.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,63.08,72.54, EXCISION TUMOR SUB-Q 90G,24075,HCPCS,975,RC,,,,both,1393,975.1,,,,,,,,,,,,,,,,,,,Other,365.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,540.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,365.47,540.45, EXCIS TUMOR DEEP SUBFASC OR INTRAMU,24076,HCPCS,975,RC,,,,both,1671,1169.7,,,,,,,,,,,,,,,,,,,Other,597.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,519.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,519.96,597.96, EXCISION OLECRANON BURSA,24105,HCPCS,975,RC,,,,both,1277,893.9,,,,,,,,,,,,,,,,,,,Other,398.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,346.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,346.83,398.86, RMVL FOREIGN BODY UPPER ARM OR ELBOW ARE,24200,HCPCS,975,RC,,,,both,556,389.2,,,,,,,,,,,,,,,,,,,Other,162,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,230.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,162,230.23, EXC FB UPPER ARM ELBOW DEEP 90,24201,HCPCS,975,RC,,,,both,1614,1129.8,,,,,,,,,,,,,,,,,,,Other,443.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,631.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,443.05,631.21, FASCIOTOMY FOREARM BRACH ART EXPL,24495,HCPCS,975,RC,,,,both,2591,1813.7,,,,,,,,,,,,,,,,,,,Other,1002.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,871.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,871.46,1002.18, CLSD TRMT HUMERAL SHAFT FX W/O MANI,24500,HCPCS,975,RC,,,,both,1241,868.7,,,,,,,,,,,,,,,,,,,Other,386.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,395.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,386.8,395.82, HUMERAL SHAFT FX W/ INSERTION OF IM IMPL,24516,HCPCS,975,RC,,,,both,3410,2387,,,,,,,,,,,,,,,,,,,Other,920.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,800.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,800.71,920.82, "HUMERAL SHAFT FX W/ INSERTION OF IM IMPL,ASSISTANT PRACTITIONER",24516,HCPCS,975,RC,AS,,,both,853,597.1,,,,,,,,,,,,,,,,,,,Other,147.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,128.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,128.12,147.33, TRMT FX HUMERUS SUPRA/TRANSCONDYLAR,24530,HCPCS,975,RC,,,,both,1347,942.9,,,,,,,,,,,,,,,,,,,Other,399.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,414.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,399.94,414.72, CLSD TRMT HUMERAL CONDYLE FRACTURE,24576,HCPCS,975,RC,,,,both,1222,855.4,,,,,,,,,,,,,,,,,,,Other,372.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,388.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,372.88,388.8, TRMT CLOSED ELBOW DISLOCATION,24600,HCPCS,975,RC,,,,both,1938,1356.6,,,,,,,,,,,,,,,,,,,Other,452.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,460.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,452.69,460.3, REDUC CLSD DISLOC ELBOW W/ANES,24605,HCPCS,975,RC,,,,both,1902,1331.4,,,,,,,,,,,,,,,,,,,Other,540.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,470.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,470.05,540.56, CLSD TRMT FX W/MQNIP ULNA/ELBOW,24620,HCPCS,975,RC,,,,both,2323,1626.1,,,,,,,,,,,,,,,,,,,Other,643.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,559.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,559.8,643.76, CLOSED TRMT RADIAL HEAD W MANIPULAT,24640,HCPCS,975,RC,,,,both,443,310.1,,,,,,,,,,,,,,,,,,,Other,79.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,98.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,79.25,98.21, RADIUS HEAD FX TRMT CLOSED,24650,HCPCS,975,RC,,,,both,976,683.2,,,,,,,,,,,,,,,,,,,Other,284.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,285.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,284.39,285.85, CLSD TRTMT OF ULNAR FRACT PROX END,24670,HCPCS,975,RC,,,,both,1072,750.4,,,,,,,,,,,,,,,,,,,Other,311.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,320.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,311.51,320.2, OPEN TRTMT OF ULNAR FX (OLECRANON) W/INT,24685,HCPCS,975,RC,,,,both,2589,1812.3,,,,,,,,,,,,,,,,,,,Other,707.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,615.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,615.53,707.85, "ASST OPEN TRTMT ULNAR FX (OLECRANON)X/IN,ASSISTANT PRACTITIONER",24685,HCPCS,975,RC,AS,,,both,647,452.9,,,,,,,,,,,,,,,,,,,Other,113.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,98.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,98.48,113.26, FIRST DORSAL COMPARTMENT RELEASE,25000,HCPCS,975,RC,,,,both,1430,1001,,,,,,,,,,,,,,,,,,,Other,377.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,328.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,328.43,377.69, FASCIOTOMY DECOMPRESS FOREMARM,25024,HCPCS,975,RC,,,,both,2910,2037,,,,,,,,,,,,,,,,,,,Other,835.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,726.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,726.86,835.88, EXC SOFT MASS FOREARM WRIST > 3 CM 90G,25071,HCPCS,975,RC,,,,both,1519,1063.3,,,,,,,,,,,,,,,,,,,Other,466.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,405.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,405.54,466.37, "ASST EXC SOFT MASS FOREARM WRIST > 3 CM,ASSISTANT SURGEON",25071,HCPCS,975,RC,80,,,both,380,266,,,,,,,,,,,,,,,,,,,Other,74.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,64.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,64.89,74.62, EXCISION TUMOR SUB-Q < 3 CM 90G,25075,HCPCS,975,RC,,,,both,1362,953.4,,,,,,,,,,,,,,,,,,,Other,347.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,522.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,347.96,522.53, EXCIS TUMOR FOREARM/WRIST DEEP 90G,25076,HCPCS,975,RC,,,,both,1761,1232.7,,,,,,,,,,,,,,,,,,,Other,558.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,485.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,485.68,558.53, EXC TENDON SHEATH LESION FORE/WRIST,25110,HCPCS,975,RC,,,,both,1351,945.7,,,,,,,,,,,,,,,,,,,Other,379.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,329.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,329.96,379.45, EXCISION WRIST GANGLION,25111,HCPCS,975,RC,,,,both,1248,873.6,,,,,,,,,,,,,,,,,,,Other,357.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,311.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,311.03,357.69, GANGLION CYST WRIST RECURRENT EXC,25112,HCPCS,975,RC,,,,both,1479,1035.3,,,,,,,,,,,,,,,,,,,Other,424.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,369.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,369.09,424.45, FB EXPLORATION REMOVAL FOREARM WRIS,25248,HCPCS,975,RC,,,,both,1498,1048.6,,,,,,,,,,,,,,,,,,,Other,464.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,403.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,403.78,464.34, REPAIR TENDON/MUSCLE FLEXOR ARM,25260,HCPCS,975,RC,,,,both,2581,1806.7,,,,,,,,,,,,,,,,,,,Other,679.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,590.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,590.6,679.19, FOREARM/WRIST REPAIR TENDON/MUSCLE,25270,HCPCS,975,RC,,,,both,1959,1371.3,,,,,,,,,,,,,,,,,,,Other,533.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,463.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,463.84,533.42, CLOSED TRMT RADIAL SHAFT FX W/O MAN,25500,HCPCS,975,RC,,,,both,1024,716.8,,,,,,,,,,,,,,,,,,,Other,301.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,310.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,301.59,310.36, CLSD REDUCTION RADIUS SHAFT FX,25505,HCPCS,975,RC,,,,both,1891,1323.7,,,,,,,,,,,,,,,,,,,Other,551.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,568.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,551.61,568.72, CLSED TREATMT OF ULNAR SHAFT FRACT,25530,HCPCS,975,RC,,,,both,969,678.3,,,,,,,,,,,,,,,,,,,Other,279.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,285.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,279.44,285.73, CLSD TRMT RAD+ULN SHAFT FX W/O MAN,25560,HCPCS,975,RC,,,,both,1071,749.7,,,,,,,,,,,,,,,,,,,Other,302.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,315.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,302.24,315.11, CLSD TRMT RAD/ULN SHAFT FX W/MANIP,25565,HCPCS,975,RC,,,,both,2055,1438.5,,,,,,,,,,,,,,,,,,,Other,575.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,602.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,575.17,602.06, CLSDTRMT DIST RAD/ULN FX W/O MAN,25600,HCPCS,975,RC,,,,both,1231,861.7,,,,,,,,,,,,,,,,,,,Other,374.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,364.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,364.3,374.25, CLSD REDUCT DIST RAD/UL? FX,25605,HCPCS,975,RC,,,,both,2009,1406.3,,,,,,,,,,,,,,,,,,,Other,618.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,614.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,614.31,618.81, "DISTAL RADIAL (WRIST) EXTRA-ARTICULAR FX,ASSISTANT PRACTITIONER",25607,HCPCS,975,RC,AS,,,both,645,451.5,,,,,,,,,,,,,,,,,,,Other,127.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,110.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,110.49,127.06, DISTAL RADIAL (WRIST) EXTRA-ARTICULAR FX,25607,HCPCS,975,RC,,,,both,2581,1806.7,,,,,,,,,,,,,,,,,,,Other,794.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,690.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,690.54,794.11, OPEN DISTAL RADIAL INTRA-ARTICULAR FX W/,25608,HCPCS,975,RC,,,,both,3080,2156,,,,,,,,,,,,,,,,,,,Other,882.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,767.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,767.55,882.68, OPEN TRTMT DISTAL RADIAL INTRA-ARTICULAR,25609,HCPCS,975,RC,,,,both,4026,2818.2,,,,,,,,,,,,,,,,,,,Other,1109.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,964.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,964.81,1109.54, "OPEN DISTAL RADIAL INTRA-ARTICULAR FX W/,ASSISTANT PRACTITIONER",25608,HCPCS,975,RC,AS,,,both,770,539,,,,,,,,,,,,,,,,,,,Other,141.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,122.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,122.8,141.23, "OPEN TRTMT DISTAL RADIAL INTRA-ARTICULAR,ASSISTANT PRACTITIONER",25609,HCPCS,975,RC,AS,,,both,1007,704.9,,,,,,,,,,,,,,,,,,,Other,177.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,154.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,154.37,177.53, CLSD TRMT SCAPH/NAVIC FRACTURE,25622,HCPCS,975,RC,,,,both,1174,821.8,,,,,,,,,,,,,,,,,,,Other,326.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,333.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,326.61,333.03, CLOSED CARPAL FRACTURE TREATMENT,25630,HCPCS,975,RC,,,,both,1132,792.4,,,,,,,,,,,,,,,,,,,Other,322.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,329.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,322.85,329.46, DRAINAGE ABSCESS FINGER SIMPLE,26010,HCPCS,975,RC,,,,both,840,588,,,,,,,,,,,,,,,,,,,Other,161.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,345.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,161.08,345.98, DRAINAGE FINGER ABSCESS;COMPLICATED (EG,26011,HCPCS,975,RC,,,,both,1255,878.5,,,,,,,,,,,,,,,,,,,Other,205.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,477.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,205.31,477.98, DRAIN TENDON SHEATH ONE HAND 90G,26020,HCPCS,975,RC,,,,both,1759,1231.3,,,,,,,,,,,,,,,,,,,Other,601.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,522.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,522.94,601.38, DRAINAGE OF PALMAR BURSA SINGL HAND,26025,HCPCS,975,RC,,,,both,1835,1284.5,,,,,,,,,,,,,,,,,,,Other,456.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,397.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,397.07,456.63, INCIS BONE HAND/FINGER,26034,HCPCS,975,RC,,,,both,2122,1485.4,,,,,,,,,,,,,,,,,,,Other,593.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,515.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,515.89,593.27, FASCIOTOMY PALMAR (DUPUYTREN;S CONTRACTU,26040,HCPCS,975,RC,,,,both,1267,886.9,,,,,,,,,,,,,,,,,,,Other,343.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,298.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,298.93,343.76, FASCIOTOMY (DUPUYTREN'S CONTRACTURE); OP,26045,HCPCS,975,RC,,,,both,1813,1269.1,,,,,,,,,,,,,,,,,,,Other,511.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,445.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,445.08,511.83, TRIGGER FING TENDON SHEATH INCISION,26055,HCPCS,975,RC,,,,both,1805,1263.5,,,,,,,,,,,,,,,,,,,Other,320.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,584.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,320.02,584.31, ARTHROTOMY EXPL DRAIN FBREM CARP-MT,26070,HCPCS,975,RC,,,,both,1216,851.2,,,,,,,,,,,,,,,,,,,Other,350.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,305.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,305.05,350.81, EXCISION OF TUMOR/SOFT TISSUE OF HAND OR,26113,HCPCS,975,RC,,,,both,2129,1490.3,,,,,,,,,,,,,,,,,,,Other,581.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,505.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,505.81,581.68, EXC TUMOR HAND FING SUBCUTANEOUS,26115,HCPCS,975,RC,,,,both,1668,1167.6,,,,,,,,,,,,,,,,,,,Other,361.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,553.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,361.61,553.23, EXCIS TUMOR/VASC MALFORM HAND FINGR,26116,HCPCS,975,RC,,,,both,2027,1418.9,,,,,,,,,,,,,,,,,,,Other,560.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,487.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,487.3,560.4, RADICAL RESECTION OF TUMOR HAND OR FINGE,26118,HCPCS,975,RC,,,,both,4077,2853.9,,,,,,,,,,,,,,,,,,,Other,1120.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,974.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,974.48,1120.66, FASCIECTOMY PARTIAL PALMAR W/RELEASE OF,26123,HCPCS,975,RC,,,,both,3364,2354.8,,,,,,,,,,,,,,,,,,,Other,888.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,772.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,772.21,888.05, FASCIECTOMY PRTLPALMAR W/RLSE SINGLE DIG,26125,HCPCS,975,RC,,,,both,1273,891.1,,,,,,,,,,,,,,,,,,,Other,270.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,235.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,235.2,270.48, EXC LESION TENDON SHEATH HAND/FING,26160,HCPCS,975,RC,,,,both,1835,1284.5,,,,,,,,,,,,,,,,,,,Other,345.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,612.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,345.11,612.39, EXC BONE CYST BEN TUMOR FINGER,26210,HCPCS,975,RC,,,,both,1697,1187.9,,,,,,,,,,,,,,,,,,,Other,482.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,419.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,419.48,482.4, PARTIAL EXC DISTAL PHALANX FINGER,26236,HCPCS,975,RC,,,,both,1623,1136.1,,,,,,,,,,,,,,,,,,,Other,477.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,415.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,415.03,477.29, FLEX TEND REP PRIM OR SEC W/O GRAFT,26350,HCPCS,975,RC,,,,both,2733,1913.1,,,,,,,,,,,,,,,,,,,Other,809.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,703.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,703.61,809.16, REPAIR EXTENSOR TENDON,26410,HCPCS,975,RC,,,,both,2205,1543.5,,,,,,,,,,,,,,,,,,,Other,653.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,567.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,567.93,653.12, EXTENSOR TENDON REPAIR FINGER,26418,HCPCS,975,RC,,,,both,2304,1612.8,,,,,,,,,,,,,,,,,,,Other,680.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,592.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,592.05,680.86, EXTENSOR TENDON REPAIR W/O GRFT,26433,HCPCS,975,RC,,,,both,2104,1472.8,,,,,,,,,,,,,,,,,,,Other,621.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,540.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,540.03,621.04, TENDON TRANSFER TO RESTORE INT FUNC,26497,HCPCS,975,RC,,,,both,3392,2374.4,,,,,,,,,,,,,,,,,,,Other,986.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,857.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,857.69,986.34, CAPSULOTOMY OR CAPSULECTOMY = INTERPHALA,26525,HCPCS,975,RC,,,,both,2557,1789.9,,,,,,,,,,,,,,,,,,,Other,739.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,643.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,643.16,739.64, REPAIR HAND MUSCLE,26591,HCPCS,975,RC,,,,both,1894,1325.8,,,,,,,,,,,,,,,,,,,Other,532.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,463.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,463.1,532.56, TRMT CLOSED METACARPAL FRACTURE,26600,HCPCS,975,RC,,,,both,979,685.3,,,,,,,,,,,,,,,,,,,Other,329.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,323.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,323.38,329.61, CLSDTRTMETACARPALFXWMANOPLTNEBONE,26605,HCPCS,975,RC,,,,both,1185,829.5,,,,,,,,,,,,,,,,,,,Other,345.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,358.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,345.59,358.18, OPEN TRTMT METACARPAL FX W/INTERNAL FIXA,26615,HCPCS,975,RC,,,,both,2180,1526,,,,,,,,,,,,,,,,,,,Other,618.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,538.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,538.03,618.73, CARPOMETACARPAL DISLOC THUMB CLSTR,26641,HCPCS,975,RC,,,,both,1570,1099,,,,,,,,,,,,,,,,,,,Other,429.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,449.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,429.47,449.66, CLSD TRMT FRACTURE DISLOC THUMB,26645,HCPCS,975,RC,,,,both,1622,1135.4,,,,,,,,,,,,,,,,,,,Other,441.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,465.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,441.26,465.89, METACARP DISLOC CLD TREAT W/MANIPU,26700,HCPCS,975,RC,,,,both,1322,925.4,,,,,,,,,,,,,,,,,,,Other,390.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,392.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,390.98,392.28, CLSD TRMT DISLOC METAC-PHAL W/ANES,26705,HCPCS,975,RC,,,,both,1448,1013.6,,,,,,,,,,,,,,,,,,,Other,444.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,468.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,444.19,468.74, CLOSED TREATMENT PHALANGEAL FRACTUR,26720,HCPCS,975,RC,,,,both,759,531.3,,,,,,,,,,,,,,,,,,,Other,225.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,223.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,223.24,225.46, CLOSD REDUC PHAL FX TRMT FING/THUMB,26725,HCPCS,975,RC,,,,both,1293,905.1,,,,,,,,,,,,,,,,,,,Other,360.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,379.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,360.02,379.11, SHAFT FRACTURE FINGER OR THUMB,26735,HCPCS,975,RC,,,,both,2259,1581.3,,,,,,,,,,,,,,,,,,,Other,638.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,555.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,555.43,638.75, CLSD TRMT METCARPPHAL JNT FX W/O MA,26740,HCPCS,975,RC,,,,both,871,609.7,,,,,,,,,,,,,,,,,,,Other,248.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,248.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,248.65,248.83, CLSD TRMNT HAND ART FX W/MANIP,26742,HCPCS,975,RC,,,,both,1407,984.9,,,,,,,,,,,,,,,,,,,Other,382.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,405.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,382.87,405.85, OPEN TRMT OF ART FRACT EXT FIXATIO,26746,HCPCS,975,RC,,,,both,2758,1930.6,,,,,,,,,,,,,,,,,,,Other,784.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,681.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,681.88,784.17, CLOSED TREATMT OF DIST PHALAN FX,26750,HCPCS,975,RC,,,,both,740,518,,,,,,,,,,,,,,,,,,,Other,229.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,210.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,210.12,229.28, CLSD TRMT DIST PHAL FX W MANIP,26755,HCPCS,975,RC,,,,both,1238,866.6,,,,,,,,,,,,,,,,,,,Other,334.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,364.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,334.89,364.42, PERC SKELETAL FIXATION DIST PHAL,26756,HCPCS,975,RC,,,,both,1567,1096.9,,,,,,,,,,,,,,,,,,,Other,462.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,402.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,402.42,462.78, OPEN FRACTURE TRMT DISTAL PHALNGES,26765,HCPCS,975,RC,,,,both,1866,1306.2,,,,,,,,,,,,,,,,,,,Other,546.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,475.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,475.52,546.84, CLOSED TREATMENT INTERPHAL DISLOC,26770,HCPCS,975,RC,,,,both,1145,801.5,,,,,,,,,,,,,,,,,,,Other,343.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,347.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,343.46,347.08, CLSD TRTMT IP JOINT W MANIP & ANEST,26775,HCPCS,975,RC,,,,both,1394,975.8,,,,,,,,,,,,,,,,,,,Other,398.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,419.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,398.78,419.98, OPEN TRMT INTERPHAL JOINT DISLOC,26785,HCPCS,975,RC,,,,both,1908,1335.6,,,,,,,,,,,,,,,,,,,Other,591.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,514.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,514.13,591.24, ARTHRODESIS; INTERPHALANGEAL JT W/WO INT,26860,HCPCS,975,RC,,,,both,1438,1006.6,,,,,,,,,,,,,,,,,,,Other,661.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,575.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,575.63,661.98, ARTHRODESIS; INTERPHALANGEAL JT W/WO INT,26861,HCPCS,975,RC,,,,both,250,175,,,,,,,,,,,,,,,,,,,Other,103.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,89.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,89.78,103.24, AMPUTATION METACARPAL,26910,HCPCS,975,RC,,,,both,2706,1894.2,,,,,,,,,,,,,,,,,,,Other,823.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,715.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,715.9,823.29, AMPUTATION FINGER/ THUMB W CLOSURE,26951,HCPCS,975,RC,,,,both,2493,1745.1,,,,,,,,,,,,,,,,,,,Other,767.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,667.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,667.46,767.58, I/D ABSCESS HIP AREA 90G,26990,HCPCS,975,RC,,,,both,2396,1677.2,,,,,,,,,,,,,,,,,,,Other,746.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,648.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,648.95,746.29, ARTHROTOMY HIP W/DRAINAGE (INFECTION),27030,HCPCS,975,RC,,,,both,3855,2698.5,,,,,,,,,,,,,,,,,,,Other,998.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,868.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,868.04,998.25, BX SOFT TISS HIP/PELV AREA DEEP 90G,27041,HCPCS,975,RC,,,,both,2538,1776.6,,,,,,,,,,,,,,,,,,,Other,755.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,657.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,657.09,755.66, EXC TUMOR PELVIS HIP AREA SUBQ,27047,HCPCS,975,RC,,,,both,1584,1108.8,,,,,,,,,,,,,,,,,,,Other,405.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,516.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,405.33,516.22, COCCYGECTOMY,27080,HCPCS,975,RC,,,,both,2086,1460.2,,,,,,,,,,,,,,,,,,,Other,578.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,503.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,503.07,578.53, INJECTION FOR SACROLIAC JOINT,27096,HCPCS,975,RC,,,,both,840,588,,,,,,,,,,,,,,,,,,,Other,84.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,164.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,84.09,164.28, ARTHROPLASTY HIP (TOTAL HIP REPLACEMENT),27130,HCPCS,975,RC,,,,both,6924,4846.8,,,,,,,,,,,,,,,,,,,Other,1357.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1180.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1180.29,1357.34, "ARTHROPLASTY HIP (TOTAL HIP REPLACEMENT),ASSISTANT PRACTITIONER",27130,HCPCS,975,RC,AS,,,both,1731,1211.7,,,,,,,,,,,,,,,,,,,Other,217.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,188.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,188.85,217.18, PERCUTANEOUS SKELETAL FIXATION FEMORAL F,27235,HCPCS,975,RC,,,,both,4057,2839.9,,,,,,,,,,,,,,,,,,,Other,966.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,840.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,840.6,966.69, OPEN TRMT OF FEMORAL FX INTERNAL FIXATIO,27236,HCPCS,975,RC,,,,both,4889,3422.3,,,,,,,,,,,,,,,,,,,Other,1265.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1100.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1100.85,1265.98, "PERCUTANEOUS SKELETAL FIXAT FEMORAL FX P,ASSISTANT PRACTITIONER",27235,HCPCS,975,RC,AS,,,both,1014,709.8,,,,,,,,,,,,,,,,,,,Other,154.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,134.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,134.5,154.67, "ASST OPEN TRMT OF FEMORAL FX INTERNAL FI,ASSISTANT PRACTITIONER",27236,HCPCS,975,RC,AS,,,both,1222,855.4,,,,,,,,,,,,,,,,,,,Other,202.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,176.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,176.14,202.56, INTERTROCHANTERIC FEMORAL FX; W/PLATE/SC,27244,HCPCS,975,RC,,,,both,4658,3260.6,,,,,,,,,,,,,,,,,,,Other,1303.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1133.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1133.52,1303.55, INTERTROCHANTERIC FEMORAL FRACTURE (HIP,27245,HCPCS,975,RC,,,,both,5059,3541.3,,,,,,,,,,,,,,,,,,,Other,1299.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1129.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1129.98,1299.48, "INTERTROCHANTERIC FEMORAL FX; W/PLATE/SC,ASSISTANT PRACTITIONER",27244,HCPCS,975,RC,AS,,,both,1165,815.5,,,,,,,,,,,,,,,,,,,Other,208.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,181.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,181.36,208.56, "INTERTROCHANTERIC FEMORAL FRACTURE (HIP,ASSISTANT PRACTITIONER",27245,HCPCS,975,RC,AS,,,both,1265,885.5,,,,,,,,,,,,,,,,,,,Other,207.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,180.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,180.8,207.92, OPEN TRTMT GREATER TROCHANTERIC FX INCLD,27248,HCPCS,975,RC,,,,both,2910,2037,,,,,,,,,,,,,,,,,,,Other,794.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,690.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,690.49,794.06, INCIS/DRAIN DP ABCESS THIGHKNEE 90G,27301,HCPCS,975,RC,,,,both,2081,1456.7,,,,,,,,,,,,,,,,,,,Other,555.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,693.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,555.9,693.78, FASCIOTOMY ILIOTIBIAL OPEN,27305,HCPCS,975,RC,,,,both,1751,1225.7,,,,,,,,,,,,,,,,,,,Other,528.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,459.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,459.17,528.04, BX DEEP SOFT TISSUE THIGH/KNEE,27324,HCPCS,975,RC,,,,both,1508,1055.6,,,,,,,,,,,,,,,,,,,Other,457.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,398.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,398.14,457.87, EXCISION MASS/TUMOR SUBQ KNEE/THIGH 90G,27327,HCPCS,975,RC,,,,both,1428,999.6,,,,,,,,,,,,,,,,,,,Other,351.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,512.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,351.83,512.15, EXICIS DEEP SUBFASCIAL OR INTRAM 90G,27328,HCPCS,975,RC,,,,both,2125,1487.5,,,,,,,,,,,,,,,,,,,Other,683.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,594.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,594.35,683.5, KNEE ARTHROTOMY W/SYNOVIAL BX 90G,27330,HCPCS,975,RC,,,,both,1802,1261.4,,,,,,,,,,,,,,,,,,,Other,467.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,406.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,406.33,467.27, EXC SOFT TISS MASS THIGH/KNEE >3CM 90G,27337,HCPCS,975,RC,,,,both,1552,1086.4,,,,,,,,,,,,,,,,,,,Other,472.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,411.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,411.17,472.84, EXC THIGH/KNEE TUMOR SOFT TISSUE >5CM 90,27339,HCPCS,975,RC,,,,both,2875,2012.5,,,,,,,,,,,,,,,,,,,Other,832.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,723.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,723.76,832.32, "ASST EXC THIGH/KNEE TUMOR SOFT TISSUE >5,ASSISTANT SURGEON",27339,HCPCS,975,RC,80,,,both,719,503.3,,,,,,,,,,,,,,,,,,,Other,133.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,115.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,115.8,133.17, EXCISION OF BONE CYST/BENIGN TUMOR OF FE,27355,HCPCS,975,RC,,,,both,2701,1890.7,,,,,,,,,,,,,,,,,,,Other,659.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,573.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,573.82,659.89, EXC PARTIAL BONE LEG,27360,HCPCS,975,RC,,,,both,4036,2825.2,,,,,,,,,,,,,,,,,,,Other,976.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,849,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,849,976.35, FB DEEP REMOVAL THIGH/KNEE,27372,HCPCS,975,RC,,,,both,1723,1206.1,,,,,,,,,,,,,,,,,,,Other,445.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,608.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,445.61,608.93, LATERAL RETINACULAR RELEASE REPAIR/REVIS,27425,HCPCS,975,RC,,,,both,2160,1512,,,,,,,,,,,,,,,,,,,Other,500.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,434.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,434.88,500.1, "LATERAL RETINACULAR RELEASE REPAIR/REVIS,ASSISTANT PRACTITIONER",27425,HCPCS,975,RC,AS,,,both,540,378,,,,,,,,,,,,,,,,,,,Other,80.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,69.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,69.58,80.02, ARTHORPLASTY KNEE (TOTAL KNEE REPLACEMEN,27447,HCPCS,975,RC,,,,both,6445,4511.5,,,,,,,,,,,,,,,,,,,Other,1353.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1177.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1177.26,1353.85, "ARTHROPLASTY KNEE (TOTAL KNEE REPLACEMEN,ASSISTANT PRACTITIONER",27447,HCPCS,975,RC,AS,,,both,1611,1127.7,,,,,,,,,,,,,,,,,,,Other,216.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,188.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,188.37,216.62, FEMUR FRACTURE TREATMENT CLOSED,27500,HCPCS,975,RC,,,,both,1916,1341.2,,,,,,,,,,,,,,,,,,,Other,530.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,559.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,530.56,559.38, OPEN FEMORAL FX W/PLATE AND SCREWS,27507,HCPCS,975,RC,,,,both,4286,3000.2,,,,,,,,,,,,,,,,,,,Other,1028.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,894.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,894.29,1028.43, "OPEN FEMORAL FX W/PLATE AND SCREWS ASST,ASSISTANT SURGEON",27507,HCPCS,975,RC,80,,,both,1072,750.4,,,,,,,,,,,,,,,,,,,Other,164.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,143.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,143.09,164.55, OPEN TRTMT OF FEMORAL FRACTURE INTERNAL,27513,HCPCS,975,RC,,,,both,5098,3568.6,,,,,,,,,,,,,,,,,,,Other,1297.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1128.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1128.1,1297.31, "OPEN TRTMT OF FEMORAL FRACTURE INTERNAL,ASSISTANT PRACTITIONER",27513,HCPCS,975,RC,AS,,,both,1275,892.5,,,,,,,,,,,,,,,,,,,Other,207.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,180.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,180.5,207.57, CLOSED TRMT TIBIAL FRACTURE PROXIML,27530,HCPCS,975,RC,,,,both,1284,898.8,,,,,,,,,,,,,,,,,,,Other,331.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,330.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,330.93,331.06, CLSD TRMT PATELLAR DISLOC W/O ANES,27560,HCPCS,975,RC,,,,both,1646,1152.2,,,,,,,,,,,,,,,,,,,Other,444.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,447.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,444.67,447.94, MANIPULATION OF KNEE JT UNDER ANESTHESIA,27570,HCPCS,975,RC,,,,both,743,520.1,,,,,,,,,,,,,,,,,,,Other,169.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,147.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,147.04,169.1, AMPUTATION ABOVE KNEE,27590,HCPCS,975,RC,,,,both,2964,2074.8,,,,,,,,,,,,,,,,,,,Other,865.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,752.19,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,752.19,865.02, AMPUTATION THIGH W CAST,27591,HCPCS,975,RC,,,,both,3559,2491.3,,,,,,,,,,,,,,,,,,,Other,1030.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,896.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,896.16,1030.59, RE-AMPUTATION THIGH THROUGH FEMUR,27596,HCPCS,975,RC,,,,both,2702,1891.4,,,,,,,,,,,,,,,,,,,Other,779.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,678.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,678.05,779.76, AMPUTATION AT KNEE,27598,HCPCS,975,RC,,,,both,2817,1971.9,,,,,,,,,,,,,,,,,,,Other,765.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,665.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,665.34,765.14, INCIS DECOMPRESSION FASCIOTOMY LEG,27600,HCPCS,975,RC,,,,both,1611,1127.7,,,,,,,,,,,,,,,,,,,Other,435.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,378.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,378.91,435.75, FASCIOTOMY FOUR COMPARTMENT 90,27602,HCPCS,975,RC,,,,both,1856,1299.2,,,,,,,,,,,,,,,,,,,Other,527.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,458.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,458.88,527.71, I&D LEG OR ANKLE DEEP ABSCESS G90,27603,HCPCS,975,RC,,,,both,1741,1218.7,,,,,,,,,,,,,,,,,,,Other,421.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,521.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,421.39,521.53, BX SOFT TISSUE LOWER EXT SUPERF 10,27613,HCPCS,975,RC,,,,both,668,467.6,,,,,,,,,,,,,,,,,,,Other,170.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,246.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,170.49,246.58, BX LEG/ANKLE DEEP,27614,HCPCS,975,RC,,,,both,1803,1262.1,,,,,,,,,,,,,,,,,,,Other,444.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,581.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,444.18,581.7, EXC TUMOR LEG DEEP,27619,HCPCS,975,RC,,,,both,1665,1165.5,,,,,,,,,,,,,,,,,,,Other,498.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,433.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,433.53,498.57, EXC CYST/GANGL LEG/ANKLE (ASST NA) 90G,27630,HCPCS,975,RC,,,,both,1653,1157.1,,,,,,,,,,,,,,,,,,,Other,390.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,536.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,390.15,536.49, REP PRIM RUPT ACHILLES TENDON,27650,HCPCS,975,RC,,,,both,2541,1778.7,,,,,,,,,,,,,,,,,,,Other,707.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,614.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,614.98,707.23, FASCIA REPAIR,27656,HCPCS,975,RC,,,,both,2048,1433.6,,,,,,,,,,,,,,,,,,,Other,360.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,501.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,360.24,501.82, TENDON REPAIR,27664,HCPCS,975,RC,,,,both,1527,1068.9,,,,,,,,,,,,,,,,,,,Other,386.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,336.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,336.05,386.46, REMOVAL OF ANKLE IMPLANT (HARDWARE),27704,HCPCS,975,RC,,,,both,2198,1538.6,,,,,,,,,,,,,,,,,,,Other,601.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,523.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,523.22,601.71, CLSD TRMT TIBIAL SHAFT FX W/O MANIP,27750,HCPCS,975,RC,,,,both,1322,925.4,,,,,,,,,,,,,,,,,,,Other,370.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,377.67,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,370.75,377.67, CLSD TRMT TIB SHAFT FX W/MANIP 90G,27752,HCPCS,975,RC,,,,both,2109,1476.3,,,,,,,,,,,,,,,,,,,Other,567.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,590.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,567.98,590.12, TRTMT CLOSED DISTAL TIBIAL FX,27760,HCPCS,975,RC,,,,both,1201,840.7,,,,,,,,,,,,,,,,,,,Other,353.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,358.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,353.58,358.27, FIBULA FX PROXIMAL CLOSED TRMT,27780,HCPCS,975,RC,,,,both,1068,747.6,,,,,,,,,,,,,,,,,,,Other,329.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,335.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,329.3,335.96, CLO TR DISTAL FIBULA FX 90G,27786,HCPCS,975,RC,,,,both,1129,790.3,,,,,,,,,,,,,,,,,,,Other,324.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,333.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,324.94,333.05, CLOSED DIST FIB FX W MANIPULATION,27788,HCPCS,975,RC,,,,both,1659,1161.3,,,,,,,,,,,,,,,,,,,Other,465.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,480.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,465.2,480.12, OPEN TRMT DISTAL FIRULAR FRACTURE,27792,HCPCS,975,RC,,,,both,2512,1758.4,,,,,,,,,,,,,,,,,,,Other,692.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,602.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,602.46,692.82, ANKLE FX TRMT BIMALLEOLAR,27808,HCPCS,975,RC,,,,both,1207,844.9,,,,,,,,,,,,,,,,,,,Other,353.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,362.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,353.1,362.92, CLSD TRMT BIMAL FX ANKLE,27810,HCPCS,975,RC,,,,both,2175,1522.5,,,,,,,,,,,,,,,,,,,Other,523.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,542.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,523.33,542.64, ANKLE FRACTURE OPEN W/INTERNAL FIXATION,27814,HCPCS,975,RC,,,,both,3002,2101.4,,,,,,,,,,,,,,,,,,,Other,818.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,712.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,712.12,818.94, "ANKLE FRACTURE OPEN W/INTERNAL FIXATION,ASSISTANT PRACTITIONER",27814,HCPCS,975,RC,AS,,,both,751,525.7,,,,,,,,,,,,,,,,,,,Other,131.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.93,131.03, CLSD TRMT TRIMALL FX W MANIPULATION,27818,HCPCS,975,RC,,,,both,2245,1571.5,,,,,,,,,,,,,,,,,,,Other,538.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,565.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,538.84,565.69, FX TRMT TIB/FIB W MANIPULATION,27825,HCPCS,975,RC,,,,both,2128,1489.6,,,,,,,,,,,,,,,,,,,Other,547.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,587.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,547.21,587.91, OPEN TRTMT OF DISTAL TIBIOFIBULAR JT INC,27829,HCPCS,975,RC,,,,both,2498,1748.6,,,,,,,,,,,,,,,,,,,Other,760.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,661.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,661.3,760.5, "ASST OPEN TRTMT OF DISTAL TIBIOFIBULAR J,ASSISTANT PRACTITIONER",27829,HCPCS,975,RC,AS,,,both,625,437.5,,,,,,,,,,,,,,,,,,,Other,121.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,105.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,105.81,121.68, CLSD TRMT ANKLE DISLOCATION W/O ANE,27840,HCPCS,975,RC,,,,both,1928,1349.6,,,,,,,,,,,,,,,,,,,Other,507.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,441.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,441.46,507.68, AMPUTATION BELOW KNEE THRU TIB FIB,27880,HCPCS,975,RC,,,,both,3204,2242.8,,,,,,,,,,,,,,,,,,,Other,985.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,856.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,856.84,985.37, TIB-FIB AMP W CAST,27881,HCPCS,975,RC,,,,both,3206,2244.2,,,,,,,,,,,,,,,,,,,Other,901.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,784.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,784.04,901.65, GUILLOTINE AMPUTATION LEG,27882,HCPCS,975,RC,,,,both,2403,1682.1,,,,,,,,,,,,,,,,,,,Other,657.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,572.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,572.13,657.95, "ASST AMPUTATION BELOW KNEE THRU TIB FIB,ASSISTANT SURGEON",27880,HCPCS,975,RC,80,,,both,875,612.5,,,,,,,,,,,,,,,,,,,Other,157.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,137.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,137.09,157.66, AMP LEG BK 2ND CLOSURE/REVISION,27884,HCPCS,975,RC,,,,both,2081,1456.7,,,,,,,,,,,,,,,,,,,Other,641.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,558.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,558.05,641.76, RE-AMPUTATION,27886,HCPCS,975,RC,,,,both,2603,1822.1,,,,,,,,,,,,,,,,,,,Other,709.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,616.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,616.57,709.05, DECOMPRESSION FASCIOTOMY LEG; W/DEBRIDEM,27892,HCPCS,975,RC,,,,both,2100,1470,,,,,,,,,,,,,,,,,,,Other,598.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,520.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,520.24,598.28, DEEP DISSECTION FOOT SINGLE SPACE,28002,HCPCS,975,RC,,,,both,1161,812.7,,,,,,,,,,,,,,,,,,,Other,145.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,229.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,145.97,229.73, DEEP DISSECTION FOOT MULT SPACES,28003,HCPCS,975,RC,,,,both,1832,1282.4,,,,,,,,,,,,,,,,,,,Other,267.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,360.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,267.56,360.27, DEEP INCISION/ DEBRIDEMENT FOOT BONE,28005,HCPCS,975,RC,,,,both,1737,1215.9,,,,,,,,,,,,,,,,,,,Other,603.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,525.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,525.08,603.85, TARSAL TUNNEL RELEASE,28035,HCPCS,975,RC,,,,both,1744,1220.8,,,,,,,,,,,,,,,,,,,Other,386.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,516.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,386.49,516.59, FOOT TOE SOFT TISS TUMOR >1.5CM,28039,HCPCS,975,RC,,,,both,1393,975.1,,,,,,,,,,,,,,,,,,,Other,356.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,454.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,356.16,454.05, EXCISION TUMOR FOOT SQ,28043,HCPCS,975,RC,,,,both,1057,739.9,,,,,,,,,,,,,,,,,,,Other,277.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,361.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,277.1,361.38, FOOT EXC CYST GANGLION,28090,HCPCS,975,RC,,,,both,1200,840,,,,,,,,,,,,,,,,,,,Other,329.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,442.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,329.41,442.74, GANGLION CYST TOE EXCISION,28092,HCPCS,975,RC,,,,both,1085,759.5,,,,,,,,,,,,,,,,,,,Other,290.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,396.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,290.04,396.85, OSTECTOMY PART EXC 5TH METAHEAD,28110,HCPCS,975,RC,,,,both,1286,900.2,,,,,,,,,,,,,,,,,,,Other,315.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,439.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,315.12,439.59, OSTECTOMY COMPLETE EXC; OTHER META 90G,28112,HCPCS,975,RC,,,,both,1367,956.9,,,,,,,,,,,,,,,,,,,Other,332.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,454.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,332.29,454.51, OSTECTOMY COMPLETE EXC; 5TH METATARSAL H,28113,HCPCS,975,RC,,,,both,1555,1088.5,,,,,,,,,,,,,,,,,,,Other,452.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,552.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,452.46,552.73, OSTECTOMY FOR SPUR W OR W/O PLANTAR FASC,28119,HCPCS,975,RC,,,,both,1518,1062.6,,,,,,,,,,,,,,,,,,,Other,388.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,502.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,388.24,502.56, PARTIAL EXC METATARSAL BONE,28122,HCPCS,975,RC,,,,both,1676,1173.2,,,,,,,,,,,,,,,,,,,Other,468.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,570.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,468.51,570.86, TOE PARTIAL RESECTION PHALANX 90G,28124,HCPCS,975,RC,,,,both,1267,886.9,,,,,,,,,,,,,,,,,,,Other,354.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,448.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,354.67,448.26, METATARSECTOMY 90G,28140,HCPCS,975,RC,,,,both,1614,1129.8,,,,,,,,,,,,,,,,,,,Other,452.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,541.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,452.17,541.42, FB REMOVAL SUBCUTANEOUS FOOT 10,28190,HCPCS,975,RC,,,,both,735,514.5,,,,,,,,,,,,,,,,,,,Other,142.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,224.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,142.84,224.32, REMOVAL OF FB FOOT SUCUTAN (DEEP),28192,HCPCS,975,RC,,,,both,1267,886.9,,,,,,,,,,,,,,,,,,,Other,328.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,431.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,328.61,431.89, FB DEEP COMPLICATED FOOT,28193,HCPCS,975,RC,,,,both,1435,1004.5,,,,,,,,,,,,,,,,,,,Other,382.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,484.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,382.7,484.89, TENOTOMY OPEN EXTENSOR FOOT OR TOE,28234,HCPCS,975,RC,,,,both,982,687.4,,,,,,,,,,,,,,,,,,,Other,288.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,386.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,288.76,386.18, METATARSAL HEAD OSTECTOMY PARTIAL 90G,28288,HCPCS,975,RC,,,,both,1566,1096.2,,,,,,,,,,,,,,,,,,,Other,464.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,577.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,464.42,577.48, SESAMOIDECTOMY 1ST TOE 90G,28315,HCPCS,975,RC,,,,both,1275,892.5,,,,,,,,,,,,,,,,,,,Other,349.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,456.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,349.15,456.03, CLOSED TRMT CALCANEUS FX W/O MANIP,28400,HCPCS,975,RC,,,,both,899,629.3,,,,,,,,,,,,,,,,,,,Other,257.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,256.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,256.95,257.34, CLSD TREATMENT OF TARSAL BONE FX,28450,HCPCS,975,RC,,,,both,781,546.7,,,,,,,,,,,,,,,,,,,Other,213.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,218.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,213.36,218.7, FRACTURE TARSAL BONE OPEN TRMT,28465,HCPCS,975,RC,,,,both,2281,1596.7,,,,,,,,,,,,,,,,,,,Other,698.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,607.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,607.74,698.9, TRMT CLOSED METATARSAL FRACTURE,28470,HCPCS,975,RC,,,,both,746,522.2,,,,,,,,,,,,,,,,,,,Other,228.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,223.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,223.99,228.38, CLSD TRMT MTATARSAL FX W/O MAN,28475,HCPCS,975,RC,,,,both,854,597.8,,,,,,,,,,,,,,,,,,,Other,250.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,263.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,250.1,263.49, CLOSED TRTMT FRACT GRT TOE-W/O MAN,28490,HCPCS,975,RC,,,,both,527,368.9,,,,,,,,,,,,,,,,,,,Other,143.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,148.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,143.98,148.81, FX TRMT CLOSED TOE W/O MANIPULATION,28510,HCPCS,975,RC,,,,both,483,338.1,,,,,,,,,,,,,,,,,,,Other,135.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,123.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,123.59,135.94, CLSD TRMT FRACTURE PHALANGES W/MANI,28515,HCPCS,975,RC,,,,both,589,412.3,,,,,,,,,,,,,,,,,,,Other,158.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,164.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,158.53,164.16, CLSD TRMT TARSOMETATARSAL DISLOC,28600,HCPCS,975,RC,,,,both,633,443.1,,,,,,,,,,,,,,,,,,,Other,173.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,179.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,173.18,179.58, AMPUTATION TRANSMETATARSAL,28805,HCPCS,975,RC,,,,both,2390,1673,,,,,,,,,,,,,,,,,,,Other,746.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,649.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,649.45,746.87, AMPUTATION METATARSAL W/TOE SINGLE 90G,28810,HCPCS,975,RC,,,,both,1389,972.3,,,,,,,,,,,,,,,,,,,Other,452.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,393.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,393.88,452.97, AMP TOE MP JOINT 90G,28820,HCPCS,975,RC,,,,both,1574,1101.8,,,,,,,,,,,,,,,,,,,Other,187.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,284.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,187.82,284.65, AMPUTATION TOE INTER PHALANGEAL JNT 90G,28825,HCPCS,975,RC,,,,both,1501,1050.7,,,,,,,,,,,,,,,,,,,Other,181.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,277.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,181.25,277.15, UNDER BODY AND UPPER EXTREMITY CASTING,29010,HCPCS,960,RC,,,,both,723,506.1,,,,,,,,,,,,,,,,,,,Other,174.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,298.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,174.85,298.78, LONG ARM PLASTER CAST APPLICATION,29065,HCPCS,960,RC,,,,both,330,231,,,,,,,,,,,,,,,,,,,Other,73.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,102.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,73.27,102.86, CAST SHORT-ARM ELBOW TO FINGER 00G,29075,HCPCS,960,RC,,,,both,297,207.9,,,,,,,,,,,,,,,,,,,Other,66.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,92.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,66.37,92.37, HAND/FOREARM CAST APPLICATION,29085,HCPCS,960,RC,,,,both,329,230.3,,,,,,,,,,,,,,,,,,,Other,71.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,101.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,71.99,101.46, APPLICATION OF SPLINT LONG ARM 00G,29105,HCPCS,960,RC,,,,both,302,211.4,,,,,,,,,,,,,,,,,,,Other,45.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,92.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,45.55,92.81, APPLICATION OF SPLINT SHORT ARM SPLINT S,29125,HCPCS,960,RC,,,,both,238,166.6,,,,,,,,,,,,,,,,,,,Other,46.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,74.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,46.08,74.14, SPLINT SHORT ARM DYNAMIC,29126,HCPCS,960,RC,,,,both,279,195.3,,,,,,,,,,,,,,,,,,,Other,51.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,80.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,51.11,80.3, APPLICATION FINGER SPLINTING,29130,HCPCS,960,RC,,,,both,143,100.1,,,,,,,,,,,,,,,,,,,Other,30.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,44.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.03,44.34, STRAPPING - SHOULDER,29240,HCPCS,960,RC,,,,both,107,74.9,,,,,,,,,,,,,,,,,,,Other,17.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.3,27, WRIST/ELBOW STRAPPING,29260,HCPCS,960,RC,,,,both,117,81.9,,,,,,,,,,,,,,,,,,,Other,17.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.88,27.2, APPLICATION OF LONG LEG CAST,29345,HCPCS,960,RC,,,,both,453,317.1,,,,,,,,,,,,,,,,,,,Other,105.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,142.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,105.02,142.72, CAST CYINDER THIGH TO ANKLE,29365,HCPCS,960,RC,,,,both,436,305.2,,,,,,,,,,,,,,,,,,,Other,93.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,132.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,93.93,132.49, APPLICATION SHORT LEG CAST,29405,HCPCS,960,RC,,,,both,297,207.9,,,,,,,,,,,,,,,,,,,Other,63.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,83.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,63.13,83.58, CAST APPLICATION SHORT LEG WALKING,29425,HCPCS,960,RC,,,,both,290,203,,,,,,,,,,,,,,,,,,,Other,57.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,76.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,57.34,76.46, APPL WALKER TO CAST,29440,HCPCS,960,RC,,,,both,129,90.3,,,,,,,,,,,,,,,,,,,Other,29.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,42.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,29.52,42.11, RIGID TOTAL CONTACT LEG CASTING,29445,HCPCS,960,RC,,,,both,453,317.1,,,,,,,,,,,,,,,,,,,Other,103.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,127.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,103.73,127.56, SPLINT LONG LEG,29505,HCPCS,960,RC,,,,both,266,186.2,,,,,,,,,,,,,,,,,,,Other,61.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,102.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,61.74,102.69, APPLICATION SHORT LEG SPLINT FOOT,29515,HCPCS,960,RC,,,,both,230,161,,,,,,,,,,,,,,,,,,,Other,56.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,78.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,56.48,78.39, STRAPPING KNEE,29530,HCPCS,960,RC,,,,both,106,74.2,,,,,,,,,,,,,,,,,,,Other,17.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.3,27, UNNA BOOT APPLICATION 00G,29580,HCPCS,960,RC,,,,both,153,107.1,,,,,,,,,,,,,,,,,,,Other,27.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,59.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.55,59.51, REMOVAL OR BIVALVING: GAUNTLET;CAST,29700,HCPCS,960,RC,,,,both,179,125.3,,,,,,,,,,,,,,,,,,,Other,34.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,65.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.97,65.38, REMOVE/BIVALVE FULL ARM/LEG CAST,29705,HCPCS,960,RC,,,,both,240,168,,,,,,,,,,,,,,,,,,,Other,47.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,67.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,47.54,67.03, WINDOWING OF CAST,29730,HCPCS,960,RC,,,,both,195,136.5,,,,,,,,,,,,,,,,,,,Other,45.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,64.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,45.2,64.7, WEDGING OF CAST,29740,HCPCS,960,RC,,,,both,284,198.8,,,,,,,,,,,,,,,,,,,Other,71.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,105.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,71.16,105.81, UNNA BOOT 2ND FOR IPAC,29799,HCPCS,960,RC,,,,both,80,56,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ARTHROCOPY SHOULDER DEBRIDEMENT 1 - 2 ST,29822,HCPCS,975,RC,,,,both,2619,1833.3,,,,,,,,,,,,,,,,,,,Other,587.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,511.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,511.24,587.92, ARTHROCOPY SHOULDER DEBRIDEMENT EXTENSIV,29823,HCPCS,975,RC,,,,both,3225,2257.5,,,,,,,,,,,,,,,,,,,Other,638.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,555.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,555.33,638.63, "ARTHROCOPY SHOULDER DBRIDMT EXTNSV 3 OR,ASSISTANT PRACTITIONER",29823,HCPCS,975,RC,AS,,,both,806,564.2,,,,,,,,,,,,,,,,,,,Other,102.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,88.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,88.86,102.18, ARTHROSCOPY SHOULDER DECOMPRESSION OF SU,29826,HCPCS,975,RC,,,,both,2736,1915.2,,,,,,,,,,,,,,,,,,,Other,175.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,152.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,152.77,175.68, ARTHROSCOPY W/ ROTATOR CUFF REPAIR,29827,HCPCS,975,RC,,,,both,4836,3385.2,,,,,,,,,,,,,,,,,,,Other,1128.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,981.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,981.72,1128.98, "ARTHROSCOPY SHOULDER DECOMPRESSION OF SU,ASSISTANT PRACTITIONER",29826,HCPCS,975,RC,AS,,,both,684,478.8,,,,,,,,,,,,,,,,,,,Other,28.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.44,28.11, "ARTHROSCOPY W/ ROTATOR CUFF REPAIR ASST,ASSISTANT PRACTITIONER",29827,HCPCS,975,RC,AS,,,both,1209,846.3,,,,,,,,,,,,,,,,,,,Other,180.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,157.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,157.07,180.63, ARTHROSCOPY KNEE; REMOVAL OF LOOSE/FOREI,29874,HCPCS,975,RC,,,,both,2501,1750.7,,,,,,,,,,,,,,,,,,,Other,578.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,502.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,502.94,578.38, ARTHROSCOPY KNEE SURGICAL; SYNOVECTOMY,29875,HCPCS,975,RC,,,,both,2448,1713.6,,,,,,,,,,,,,,,,,,,Other,540.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,470.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,470.16,540.68, "ARTHROSCOPY KNEE SURGICAL; SYNOVECTOMY A,ASSISTANT PRACTITIONER",29875,HCPCS,975,RC,AS,,,both,612,428.4,,,,,,,,,,,,,,,,,,,Other,86.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,75.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,75.22,86.5, "ARTHROSCPY KNEE ABRASION ARTHROPLASTY; A,ASSISTANT PRACTITIONER",29879,HCPCS,975,RC,AS,,,both,789,552.3,,,,,,,,,,,,,,,,,,,Other,114.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,99.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,99.41,114.33, ARTHROSCPY KNEE ABRASION ARTHROPLASTY,29879,HCPCS,975,RC,,,,both,3156,2209.2,,,,,,,,,,,,,,,,,,,Other,714.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,621.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,621.35,714.55, ARTHROSCOPY KNEE W/MENISCECTOMY MEDIAL &,29880,HCPCS,975,RC,,,,both,3329,2330.3,,,,,,,,,,,,,,,,,,,Other,608.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,528.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,528.78,608.1, ARTHROSCOPY KNEE W/MENISCECTOMY MEDIAL O,29881,HCPCS,975,RC,,,,both,2898,2028.6,,,,,,,,,,,,,,,,,,,Other,587.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,510.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,510.72,587.32, ARTHROSCOPY KNEE W/MENISCUS REPAIR (MEDI,29882,HCPCS,975,RC,,,,both,3444,2410.8,,,,,,,,,,,,,,,,,,,Other,736.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,640.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,640.63,736.72, ARTHROSCOPY KNEE W/MENISCUS RPR (MEDIAL,29883,HCPCS,975,RC,,,,both,4235,2964.5,,,,,,,,,,,,,,,,,,,Other,905.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,787.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,787.17,905.24, "ARTHROSCOPY KNEE W/MENISCECTOMY MED & LA,ASSISTANT PRACTITIONER",29880,HCPCS,975,RC,AS,,,both,832,582.4,,,,,,,,,,,,,,,,,,,Other,97.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,84.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,84.6,97.29, "ASST ARTHROSCOPY KNEE W/MENISCECTOMY MED,ASSISTANT PRACTITIONER",29881,HCPCS,975,RC,AS,,,both,725,507.5,,,,,,,,,,,,,,,,,,,Other,93.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,81.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,81.71,93.97, "ARTHROSCOPY KNEE W/MENISCUS RPR (MEDIAL,ASSISTANT PRACTITIONER",29882,HCPCS,975,RC,AS,,,both,861,602.7,,,,,,,,,,,,,,,,,,,Other,117.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,102.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,102.5,117.87, ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE,29888,HCPCS,975,RC,,,,both,4993,3495.1,,,,,,,,,,,,,,,,,,,Other,1027.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,893.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,893.84,1027.91, "ARTHROSPCALLY AIDED ANTERIOR CRUCIATE LI,ASSISTANT PRACTITIONER",29888,HCPCS,975,RC,AS,,,both,1248,873.6,,,,,,,,,,,,,,,,,,,Other,164.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,143.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,143.01,164.46, EXCISION CYST NOSE,30124,HCPCS,975,RC,,,,both,832,582.4,,,,,,,,,,,,,,,,,,,Other,308.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,268.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,268.6,308.89, REMOVAL FOREIGN BODY INTRANASAL,30300,HCPCS,975,RC,,,,both,575,402.5,,,,,,,,,,,,,,,,,,,Other,126.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,196.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,126.3,196.79, EPISTAXIS CONTROL NASAL HEM 00G,30901,HCPCS,975,RC,,,,both,358,250.6,,,,,,,,,,,,,,,,,,,Other,59.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,155.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,59.36,155.32, CONTROL NASAL HEMORR ANTERIOR COMPL,30903,HCPCS,975,RC,,,,both,601,420.7,,,,,,,,,,,,,,,,,,,Other,83.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,248.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,83.59,248.12, EPISTAXIS CONTROL POSTERIOR/PACKS,30905,HCPCS,975,RC,,,,both,844,590.8,,,,,,,,,,,,,,,,,,,Other,117.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,367.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,117.9,367.61, NASAL/SINUS ENDO W/CONTROL OF EPIST,31238,HCPCS,975,RC,,,,both,970,679,,,,,,,,,,,,,,,,,,,Other,166.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,248.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,166.75,248.7, INTUBATION ENDOTRACH EMERGENT 00G,31500,HCPCS,975,RC,,,,both,884,618.8,,,,,,,,,,,,,,,,,,,Other,158.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,137.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,137.5,158.13, TRACHEOTOMY TUBE CHANGE PRIOR FIST,31502,HCPCS,975,RC,,,,both,222,155.4,,,,,,,,,,,,,,,,,,,Other,35.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.69,35.3, DIAGNOSTIC LARYNGOSCOPY INDIRECT,31505,HCPCS,975,RC,,,,both,238,166.6,,,,,,,,,,,,,,,,,,,Other,49.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,82.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,49.71,82.37, LARYNGOSCOPY INDIRECT WITH BX,31510,HCPCS,975,RC,,,,both,622,435.4,,,,,,,,,,,,,,,,,,,Other,120.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,203.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,120.75,203.32, DIAGNOSTIC LARYNGOSCOPY,31525,HCPCS,975,RC,,,,both,777,543.9,,,,,,,,,,,,,,,,,,,Other,159.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,240.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,159.28,240.11, LARYNGOSCOPY DIRECT OR FB REMOVAL,31530,HCPCS,975,RC,,,,both,860,602,,,,,,,,,,,,,,,,,,,Other,201.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,175.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,175.06,201.31, LARYNGOSCOPY DIRECT WITH BX,31535,HCPCS,975,RC,,,,both,959,671.3,,,,,,,,,,,,,,,,,,,Other,187.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,163.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,163.29,187.78, LARYNGOSCOPY FLEXI FIBEROPTIC DIAG,31575,HCPCS,975,RC,,,,both,400,280,,,,,,,,,,,,,,,,,,,Other,69.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,119.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,69.09,119.25, LARYNGOSCOPY FLEX DX W BX,31576,HCPCS,975,RC,,,,both,925,647.5,,,,,,,,,,,,,,,,,,,Other,119.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,251.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,119.27,251.05, TRACHEOSTOMY 0G,31600,HCPCS,975,RC,,,,both,1443,1010.1,,,,,,,,,,,,,,,,,,,Other,325.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,282.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,282.66,325.06, TRACHEOSTOMY EMERGENCY TRANSTRACH,31603,HCPCS,975,RC,,,,both,1214,849.8,,,,,,,,,,,,,,,,,,,Other,332.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,288.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,288.88,332.22, EMERG TRACHEOSTOMY CRICOTHYROID,31605,HCPCS,975,RC,,,,both,1256,879.2,,,,,,,,,,,,,,,,,,,Other,365.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,317.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,317.82,365.5, TRACHEOSTOMA REVISION SIMPLE,31613,HCPCS,975,RC,,,,both,1552,1086.4,,,,,,,,,,,,,,,,,,,Other,440.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,383.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,383.46,440.98, TRACHEOBRONCHOSCOPY THRU TRACH,31615,HCPCS,975,RC,,,,both,684,478.8,,,,,,,,,,,,,,,,,,,Other,116.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,165.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,116.81,165.22, BRONCHOSCOPY DIAGNOSTIC 00G,31622,HCPCS,975,RC,,,,both,864,604.8,,,,,,,,,,,,,,,,,,,Other,139.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,265.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,139.15,265.94, BRONCHOSCOPY W BRUSHINGS 00G,31623,HCPCS,975,RC,,,,both,798,558.6,,,,,,,,,,,,,,,,,,,Other,136.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,283.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.96,283.46, BRONCHOSCOPY W/ LAVAGE,31624,HCPCS,975,RC,,,,both,862,603.4,,,,,,,,,,,,,,,,,,,Other,138.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,268.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,138.67,268.51, BRONCH WASH BRUSH BIOPSY 00G,31625,HCPCS,975,RC,,,,both,921,644.7,,,,,,,,,,,,,,,,,,,Other,161.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,358.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,161.95,358.69, BRONCHOSCOPY W/LUNG BIOPSY,31628,HCPCS,975,RC,,,,both,1096,767.2,,,,,,,,,,,,,,,,,,,Other,182.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,382.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,182.65,382.37, BRONCHOSCOPY WITH TRANSBRONCHIALNEEDLE A,31629,HCPCS,975,RC,,,,both,1429,1000.3,,,,,,,,,,,,,,,,,,,Other,194.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,462.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,194.01,462.78, BRONCH TRACH DILATION STENT 00G,31631,HCPCS,975,RC,,,,both,1205,843.5,,,,,,,,,,,,,,,,,,,Other,231.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,201.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,201.03,231.18, BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BIOPS,31632,HCPCS,975,RC,,,,both,298,208.6,,,,,,,,,,,,,,,,,,,Other,49.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,66.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,49.57,66.11, BRONCH W REMOVAL FB,31635,HCPCS,975,RC,,,,both,1162,813.4,,,,,,,,,,,,,,,,,,,Other,182.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,307.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,182.62,307.02, BRONCHOSCOPY WITH ASPIRATION,31645,HCPCS,975,RC,,,,both,895,626.5,,,,,,,,,,,,,,,,,,,Other,153.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,290.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,153.43,290.01, INTUBATION EMERGENCY,31730,HCPCS,975,RC,,,,both,1397,977.9,,,,,,,,,,,,,,,,,,,Other,159.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1070.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,159.68,1070.97, THORACOTOMY LUNG WEDGE BX 90,32097,HCPCS,975,RC,,,,both,2975,2082.5,,,,,,,,,,,,,,,,,,,Other,917.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,797.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,797.68,917.33, THORACOTOMY WITH EXPLOR AND BIOPSY,32100,HCPCS,975,RC,,,,both,3247,2272.9,,,,,,,,,,,,,,,,,,,Other,924.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,804.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,804.04,924.65, THORACOTOMY W/CONTROL HEM+REPAIR 90,32110,HCPCS,975,RC,,,,both,5605,3923.5,,,,,,,,,,,,,,,,,,,Other,1666.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1448.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1448.88,1666.22, THORACOTOMY MAJOR W/EXC BULLAE 90G,32141,HCPCS,975,RC,,,,both,4863,3404.1,,,,,,,,,,,,,,,,,,,Other,1722.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1498.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1498.14,1722.86, THORACOTOMY W/REMOVAL OF INTRAPLEURAL FO,32150,HCPCS,975,RC,,,,both,3720,2604,,,,,,,,,,,,,,,,,,,Other,1157.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1006.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1006.46,1157.43, "THORACOTOMY W/REMOVAL OF INTRAPLEURAL FO,ASSISTANT SURGEON",32150,HCPCS,975,RC,80,,,both,930,651,,,,,,,,,,,,,,,,,,,Other,185.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,161.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,161.03,185.19, PNEUMONOSTOMY W/OPEN DRAIN OF CYST,32200,HCPCS,975,RC,,,,both,3863,2704.1,,,,,,,,,,,,,,,,,,,Other,1312.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1141.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1141.49,1312.72, THORACOTOMY DECORTICATION,32220,HCPCS,975,RC,,,,both,5535,3874.5,,,,,,,,,,,,,,,,,,,Other,1826.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1588.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1588.15,1826.37, DECORTICATION PARTIAL PULMONARY,32225,HCPCS,975,RC,,,,both,3563,2494.1,,,,,,,,,,,,,,,,,,,Other,1138.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,989.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,989.91,1138.4, "ASST DECORTICATION PARTIAL PULMONARY,ASSISTANT SURGEON",32225,HCPCS,975,RC,80,,,both,891,623.7,,,,,,,,,,,,,,,,,,,Other,182.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,158.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,158.39,182.14, PLEURAL BX PERC NEEDLE,32400,HCPCS,975,RC,,,,both,557,389.9,,,,,,,,,,,,,,,,,,,Other,84.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,157.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,84.61,157.55, CORE NEEDLE BIOPSY LUNG OR MEDIASTINUM W,32408,HCPCS,975,RC,,,,both,1000,700,,,,,,,,,,,,,,,,,,,Other,152.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,735.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,152.85,735.7, PNEUMONECTOMY 90G,32440,HCPCS,975,RC,,,,both,6294,4405.8,,,,,,,,,,,,,,,,,,,Other,1783.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1550.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1550.97,1783.61, "ASST PNEUMONECTOMY,ASSISTANT SURGEON",32440,HCPCS,975,RC,80,,,both,1574,1101.8,,,,,,,,,,,,,,,,,,,Other,285.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,248.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,248.16,285.38, LUNG LOBECTOMY 90G,32480,HCPCS,975,RC,,,,both,5602,3921.4,,,,,,,,,,,,,,,,,,,Other,1679.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1460.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1460.39,1679.45, "ASST LUNG LOBECTOMY,ASSISTANT SURGEON",32480,HCPCS,975,RC,80,,,both,1400,980,,,,,,,,,,,,,,,,,,,Other,268.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,233.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,233.66,268.71, LUNG RESECTION TWO LOBES 90G,32482,HCPCS,975,RC,,,,both,6057,4239.9,,,,,,,,,,,,,,,,,,,Other,1799.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1564.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1564.45,1799.12, "ASST LUNG RESECTION TWO LOBES,ASSISTANT SURGEON",32482,HCPCS,975,RC,80,,,both,1514,1059.8,,,,,,,,,,,,,,,,,,,Other,287.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,250.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,250.31,287.86, LUNG SINGLE SEGMENT LOBECTOMY,32484,HCPCS,975,RC,,,,both,5725,4007.5,,,,,,,,,,,,,,,,,,,Other,1625.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1413.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1413.26,1625.25, LUNG TUMOR RESECTION W/RECONSTR 90,32504,HCPCS,975,RC,,,,both,8094,5665.8,,,,,,,,,,,,,,,,,,,Other,2311.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2010.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2010.23,2311.77, EMPYEMA ENUCLEATION 90,32540,HCPCS,975,RC,,,,both,6112,4278.4,,,,,,,,,,,,,,,,,,,Other,1960.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1704.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1704.46,1960.13, PLEURAL CATH WITH CUFF INSERTION 00,32550,HCPCS,975,RC,,,,both,1906,1334.2,,,,,,,,,,,,,,,,,,,Other,211.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,722.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,211.6,722.84, TUBE THORACOSTOMY W/WATER SEAL 0G,32551,HCPCS,975,RC,,,,both,779,545.3,,,,,,,,,,,,,,,,,,,Other,170.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,148.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,148.04,170.25, THORACENTESIS NEEDLE/CATH PLEUR,32554,HCPCS,975,RC,,,,both,811,567.7,,,,,,,,,,,,,,,,,,,Other,92.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,242.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,92.39,242.61, THORACENTESIS W/ IMAGING 00,32555,HCPCS,975,RC,,,,both,681,476.7,,,,,,,,,,,,,,,,,,,Other,109.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,289.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,109.19,289.21, PLEURAL DRAINAGE PERCUTANEOUS W/INSERTIO,32556,HCPCS,975,RC,,,,both,1100,770,,,,,,,,,,,,,,,,,,,Other,132.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,767.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,132.17,767.33, PLEURAL DRAINAGE W/IMAGE PERC W/CAT,32557,HCPCS,975,RC,,,,both,999,699.3,,,,,,,,,,,,,,,,,,,Other,151.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,595.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,151.03,595.45, THORACOSCOPY DIAG W/O BIOPSY 00G,32601,HCPCS,975,RC,,,,both,1332,932.4,,,,,,,,,,,,,,,,,,,Other,346.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,301.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,301.05,346.2, THORACOSOPY W/BX MEDIASTINAL 00,32606,HCPCS,975,RC,,,,both,1888,1321.6,,,,,,,,,,,,,,,,,,,Other,517.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,450.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,450.34,517.89, THORACOSCOPY W/BX LUNG NOD/MASS 00,32608,HCPCS,975,RC,,,,both,1517,1061.9,,,,,,,,,,,,,,,,,,,Other,425.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,370.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,370.41,425.98, "ASST THORACOSOPY W/BX MEDIASTINAL,ASSISTANT SURGEON",32606,HCPCS,975,RC,80,,,both,472,330.4,,,,,,,,,,,,,,,,,,,Other,82.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,72.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.05,82.86, THORACOSCOPY W/DX BX WEDGE 00,32607,HCPCS,975,RC,,,,both,1178,824.6,,,,,,,,,,,,,,,,,,,Other,347.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,302.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,302.37,347.72, "ASST THORACOSCOPY W/BX NOD/MASS,ASSISTANT SURGEON",32608,HCPCS,975,RC,80,,,both,375,262.5,,,,,,,,,,,,,,,,,,,Other,68.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,59.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,59.27,68.16, THORACOSCOPY W/BX PLEURA 0G,32609,HCPCS,975,RC,,,,both,1039,727.3,,,,,,,,,,,,,,,,,,,Other,283.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,246.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,246.62,283.61, THORACOSCOPY SURG W/PLEURODESIS 90,32650,HCPCS,975,RC,,,,both,2818,1972.6,,,,,,,,,,,,,,,,,,,Other,766.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,666.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,666.4,766.36, THOROCOSCOPY PLEURODESIS DECORTICAT,32651,HCPCS,975,RC,,,,both,4168,2917.6,,,,,,,,,,,,,,,,,,,Other,1241.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1079.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1079.27,1241.17, "ASST THORACOSCOPY SURG W/PLEURODESIS,ASSISTANT SURGEON",32650,HCPCS,975,RC,80,,,both,705,493.5,,,,,,,,,,,,,,,,,,,Other,122.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,106.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,106.62,122.62, THORACOSCOPY W/REMOV FB/FIBRIN DEP,32653,HCPCS,975,RC,,,,both,4234,2963.8,,,,,,,,,,,,,,,,,,,Other,1197.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1040.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1040.9,1197.03, THORACOSCOPY W EXCISION BULLAE,32655,HCPCS,975,RC,,,,both,3744,2620.8,,,,,,,,,,,,,,,,,,,Other,1090.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,948.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,948.4,1090.66, THORACOSCOPY W PERICARDIAL WINDOW,32659,HCPCS,975,RC,,,,both,3185,2229.5,,,,,,,,,,,,,,,,,,,Other,846.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,736.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,736.1,846.51, LAP HELLER PROCEDURE,32665,HCPCS,975,RC,,,,both,4952,3466.4,,,,,,,,,,,,,,,,,,,Other,1398.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1216.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1216.39,1398.84, THORACOSCOP LUNG WEDGE RESECT,32666,HCPCS,975,RC,,,,both,3811,2667.7,,,,,,,,,,,,,,,,,,,Other,996.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,866.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,866.72,996.73, "ASST THORASCOPIC LUNG WEDGE RESECT,ASSISTANT SURGEON",32666,HCPCS,975,RC,80,,,both,953,667.1,,,,,,,,,,,,,,,,,,,Other,159.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,138.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,138.68,159.48, PERICARDIOCENTESIS INCLUDING IMAGING GUI,33016,HCPCS,975,RC,,,,both,885,619.5,,,,,,,,,,,,,,,,,,,Other,248.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,215.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,215.87,248.25, PACEMAKER TEMP/TRANS VENOUS 00,33210,HCPCS,975,RC,,,,both,727,508.9,,,,,,,,,,,,,,,,,,,Other,170.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,148.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,148.11,170.32, DESCEND THORAC AORTA GFT W/WO BYPAS,33875,HCPCS,975,RC,,,,both,11540,8078,,,,,,,,,,,,,,,,,,,Other,3073.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2672.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2672.93,3073.87, THORACO AAA REPAIR,33877,HCPCS,975,RC,,,,both,16903,11832.1,,,,,,,,,,,,,,,,,,,Other,4025.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3500.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3500.4,4025.47, EMBOLECTOMY NECK,34001,HCPCS,975,RC,,,,both,3335,2334.5,,,,,,,,,,,,,,,,,,,Other,1025.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,891.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,891.65,1025.4, EMBOLECTOMY AX SUBCLAV 90G,34101,HCPCS,975,RC,,,,both,2261,1582.7,,,,,,,,,,,,,,,,,,,Other,660.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,574.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,574.76,660.97, THROMBECTOMY RADIAL ULNAR ARM INCIS,34111,HCPCS,975,RC,,,,both,2358,1650.6,,,,,,,,,,,,,,,,,,,Other,660.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,574.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,574.63,660.82, EMBOLECTOMY MESENTERIC,34151,HCPCS,975,RC,,,,both,5231,3661.7,,,,,,,,,,,,,,,,,,,Other,1544.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1343.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1343.47,1544.99, FEMORAL EMBOLECTOMY 90G,34201,HCPCS,975,RC,,,,both,3684,2578.8,,,,,,,,,,,,,,,,,,,Other,1134.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,986.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,986.66,1134.66, "ASST FEMORAL EMOBLECTOMY,ASSISTANT SURGEON",34201,HCPCS,975,RC,80,,,both,921,644.7,,,,,,,,,,,,,,,,,,,Other,181.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,157.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,157.87,181.54, EMBOLECTOMY POP TIB PERONEAL 90G,34203,HCPCS,975,RC,,,,both,3429,2400.3,,,,,,,,,,,,,,,,,,,Other,1053.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,915.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,915.68,1053.04, "ASST EMBOLECTOMY POP-TIB-PERONEAL,ASSISTANT SURGEON",34203,HCPCS,975,RC,80,,,both,857,599.9,,,,,,,,,,,,,,,,,,,Other,168.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,146.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,146.51,168.48, THROMBECTOMY VENA CAVA ILIAC FEMPOP,34421,HCPCS,975,RC,,,,both,2531,1771.7,,,,,,,,,,,,,,,,,,,Other,777.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,676.19,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,676.19,777.62, CROSS OVER VEIN GRAFT,34520,HCPCS,975,RC,,,,both,4088,2861.6,,,,,,,,,,,,,,,,,,,Other,1107.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,962.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,962.83,1107.25, ENDOVASCULAR REPAIR INFRARENAL AORTA/ILL,34705,HCPCS,975,RC,,,,both,5149,3604.3,,,,,,,,,,,,,,,,,,,Other,1685.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1465.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1465.82,1685.69, "ASST ENDOVASCULAR REPAIR INFRARENAL AORT,ASSISTANT SURGEON",34705,HCPCS,975,RC,80,,,both,1287,900.9,,,,,,,,,,,,,,,,,,,Other,269.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,234.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,234.53,269.71, ENDOVASCULAR REPAIR OF ILIAC ARTERY ILIO,34707,HCPCS,975,RC,,,,both,4111,2877.7,,,,,,,,,,,,,,,,,,,Other,1285.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1117.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1117.57,1285.21, "ASST ENDOVASCULAR RPR OF ILIAC ARTERY IL,ASSISTANT SURGEON",34707,HCPCS,975,RC,80,,,both,1028,719.6,,,,,,,,,,,,,,,,,,,Other,205.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,178.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,178.81,205.63, PLCMT OF EXTENS PROSTHESIS TO ILLIAC/REN,34709,HCPCS,975,RC,,,,both,1116,781.2,,,,,,,,,,,,,,,,,,,Other,356.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,310.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,310.09,356.6, "ASST PLCMT OF EXTENS PROSTHESIS TO ILLIA,ASSISTANT SURGEON",34709,HCPCS,975,RC,80,,,both,279,195.3,,,,,,,,,,,,,,,,,,,Other,57.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,49.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,49.62,57.06, EV PLCMT ILIAC DEVICE,34808,HCPCS,975,RC,,,,both,804,562.8,,,,,,,,,,,,,,,,,,,Other,225.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,195.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,195.94,225.33, FEM ART REP OPEN/ENDOVAS STENT 00G,34812,HCPCS,975,RC,,,,both,1289,902.3,,,,,,,,,,,,,,,,,,,Other,229.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,199.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,199.17,229.04, "ASST OPEN FEMORAL ARTERY STENT,ASSISTANT SURGEON",34812,HCPCS,975,RC,80,,,both,322,225.4,,,,,,,,,,,,,,,,,,,Other,36.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,31.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.87,36.64, EVAR FEM-FEM AA REPAIR,34813,HCPCS,975,RC,,,,both,968,677.6,,,,,,,,,,,,,,,,,,,Other,262.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,228.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,228.52,262.8, AORTIC ANEURYSM REPAIR 90G,35081,HCPCS,975,RC,,,,both,6450,4515,,,,,,,,,,,,,,,,,,,Other,1930.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1678.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1678.51,1930.3, "ASST AORTIC ANEURYSM REPAIR,ASSISTANT SURGEON",35081,HCPCS,975,RC,80,,,both,1613,1129.1,,,,,,,,,,,,,,,,,,,Other,308.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,268.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,268.56,308.85, AAA REPAIR RUPTURED,35082,HCPCS,975,RC,,,,both,8111,5677.7,,,,,,,,,,,,,,,,,,,Other,2401.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2087.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2087.83,2401.01, REPAIR AAA VISCERAL MES-CEL-REN 90G,35091,HCPCS,975,RC,,,,both,7149,5004.3,,,,,,,,,,,,,,,,,,,Other,1977.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1719.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1719.41,1977.33, "ASST REPAIR AAA VISCERAL MES-CEL-REN,ASSISTANT SURGEON",35091,HCPCS,975,RC,80,,,both,1787,1250.9,,,,,,,,,,,,,,,,,,,Other,316.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,275.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,275.11,316.37, REPAIR AORTIC ANEURYSM 90G,35102,HCPCS,975,RC,,,,both,7360,5152,,,,,,,,,,,,,,,,,,,Other,2088.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1816.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1816.17,2088.59, "ASST AAA REPAIR,ASSISTANT SURGEON",35102,HCPCS,975,RC,80,,,both,1840,1288,,,,,,,,,,,,,,,,,,,Other,334.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,290.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,290.59,334.17, ANEURYSM SPLENIC ART- REPAIR/DISSEC 90G,35111,HCPCS,975,RC,,,,both,4936,3455.2,,,,,,,,,,,,,,,,,,,Other,1487.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1293.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1293.56,1487.59, ILIAC ANEURYSM GRAFT REPAIR 90G,35131,HCPCS,975,RC,,,,both,5264,3684.8,,,,,,,,,,,,,,,,,,,Other,1540.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1339.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1339.54,1540.47, FEMORAL ARTERY ANEURYSM GRAFT REP 90G,35141,HCPCS,975,RC,,,,both,4071,2849.7,,,,,,,,,,,,,,,,,,,Other,1212.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1054.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1054.46,1212.63, REPAIR-GRAFT ANEURYSM 90G,35151,HCPCS,975,RC,,,,both,4608,3225.6,,,,,,,,,,,,,,,,,,,Other,1375.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1196.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1196.14,1375.56, REPAIR ARTERIOVENOUS FISTULA EXTREM 90G,35184,HCPCS,975,RC,,,,both,3566,2496.2,,,,,,,,,,,,,,,,,,,Other,1080.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,939.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,939.21,1080.1, AV ARTERIOVENOUS FISTULA REPAIR 90G,35190,HCPCS,975,RC,,,,both,2816,1971.2,,,,,,,,,,,,,,,,,,,Other,830.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,722.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,722.15,830.47, REPAIR BLOOD VESSEL NECK DIRECT 90G,35201,HCPCS,975,RC,,,,both,3626,2538.2,,,,,,,,,,,,,,,,,,,Other,1022.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,889.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,889.24,1022.63, DIRECT REPAIR BLOOD VESSEL UPPER EX 90G,35206,HCPCS,975,RC,,,,both,3148,2203.6,,,,,,,,,,,,,,,,,,,Other,865.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,752.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,752.92,865.86, REPAIR BLD VESL INTRA-ABDOMINAL 90G,35221,HCPCS,975,RC,,,,both,5763,4034.1,,,,,,,,,,,,,,,,,,,Other,1622.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1411.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1411.05,1622.71, REPAIR LOW EXT VES COM FEM ANGIOPL,35226,HCPCS,975,RC,,,,both,3258,2280.6,,,,,,,,,,,,,,,,,,,Other,919.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,799.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,799.17,919.04, REPAIR VESSEL NECK WITH VEIN GRAFT,35231,HCPCS,975,RC,,,,both,5583,3908.1,,,,,,,,,,,,,,,,,,,Other,1276.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1110.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1110.35,1276.9, REPAIR W/ VEIN GRAFT INTRAABDOM,35251,HCPCS,975,RC,,,,both,7687,5380.9,,,,,,,,,,,,,,,,,,,Other,1904.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1656.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1656.33,1904.78, BPG REVISION LOWER EXTREMITY,35256,HCPCS,975,RC,,,,both,4069,2848.3,,,,,,,,,,,,,,,,,,,Other,1125.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,978.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,978.99,1125.84, REPAIR UE VESSEL WITH OTHER GRAFT,35266,HCPCS,975,RC,,,,both,3409,2386.3,,,,,,,,,,,,,,,,,,,Other,957.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,832.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,832.33,957.19, VESSEL GRAFT NON VEIN LOWER EXTREM,35286,HCPCS,975,RC,,,,both,3832,2682.4,,,,,,,,,,,,,,,,,,,Other,1025.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,891.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,891.47,1025.19, CAROTID ENDARTERECTOMY 90G,35301,HCPCS,975,RC,,,,both,4111,2877.7,,,,,,,,,,,,,,,,,,,Other,1254.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1090.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1090.56,1254.15, SFA THROMBOENDARTERECTOMY W/WO PATCH GRA,35302,HCPCS,975,RC,,,,both,4020,2814,,,,,,,,,,,,,,,,,,,Other,1239.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1077.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1077.87,1239.55, "ASST CAROTID ENDARTERECTOMY,ASSISTANT SURGEON",35301,HCPCS,975,RC,80,,,both,1028,719.6,,,,,,,,,,,,,,,,,,,Other,200.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,174.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,174.49,200.66, "SFA THROMBOENDARTERECTOMY W/WO PATCH GRA,ASSISTANT SURGEON",35302,HCPCS,975,RC,80,,,both,1005,703.5,,,,,,,,,,,,,,,,,,,Other,198.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,172.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,172.46,198.33, THROMBOENDARTERECTOMY ABDOM AORTA,35331,HCPCS,975,RC,,,,both,5217,3651.9,,,,,,,,,,,,,,,,,,,Other,1565.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1360.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1360.91,1565.04, THROMBOENDARTERECTOMY MES-CEL-REN90,35341,HCPCS,975,RC,,,,both,5223,3656.1,,,,,,,,,,,,,,,,,,,Other,1521.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1323.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1323.13,1521.6, ILIAC ENDARTERECTOMY,35351,HCPCS,975,RC,,,,both,4444,3110.8,,,,,,,,,,,,,,,,,,,Other,1432.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1245.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1245.95,1432.85, THROMBOENDARTERECTOMY ILIOFEMORAL 90G,35355,HCPCS,975,RC,,,,both,4041,2828.7,,,,,,,,,,,,,,,,,,,Other,1143.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,994.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,994.42,1143.58, "ASST THROMBOENDARTERECTOMY ILIOFEMORAL,ASSISTANT SURGEON",35355,HCPCS,975,RC,80,,,both,1010,707,,,,,,,,,,,,,,,,,,,Other,182.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,159.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,159.1,182.98, THROMBOENDARTERECTOMY AORTOILIAC 90,35361,HCPCS,975,RC,,,,both,5958,4170.6,,,,,,,,,,,,,,,,,,,Other,1705.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1482.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1482.82,1705.24, THROMBOENDARTERECTOMY COMMONFEMORAL 90,35371,HCPCS,975,RC,,,,both,3190,2233,,,,,,,,,,,,,,,,,,,Other,903.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,785.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,785.32,903.12, "ASST COM FEMORAL THROMBOENDARTERECTOMY,ASSISTANT SURGEON",35371,HCPCS,975,RC,80,,,both,798,558.6,,,,,,,,,,,,,,,,,,,Other,144.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,125.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,125.66,144.5, PROFUNDOPLASTY,35372,HCPCS,975,RC,,,,both,3846,2692.2,,,,,,,,,,,,,,,,,,,Other,1083.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,942.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,942.15,1083.48, "ASST PROFUNDOPLASTY,ASSISTANT SURGEON",35372,HCPCS,975,RC,80,,,both,962,673.4,,,,,,,,,,,,,,,,,,,Other,173.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,150.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,150.74,173.35, CAROTID RE-OPERATION AFT 1 YR,35390,HCPCS,975,RC,,,,both,565,395.5,,,,,,,,,,,,,,,,,,,Other,176.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,153.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,153.87,176.95, ANGIOSCOPY NO MOD,35400,HCPCS,975,RC,,,,both,558,390.6,,,,,,,,,,,,,,,,,,,Other,162.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,141.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,141.45,162.67, "ASST ANGIOSCOPY,ASSISTANT SURGEON",35400,HCPCS,975,RC,80,,,both,140,98,,,,,,,,,,,,,,,,,,,Other,26.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,22.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,22.63,26.03, HARVEST VEIN,35500,HCPCS,975,RC,,,,both,1271,889.7,,,,,,,,,,,,,,,,,,,Other,354.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,308.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,308.21,354.45, CAROTID BYPASS VEIN GRAFT ASST,35501,HCPCS,975,RC,,,,both,5671,3969.7,,,,,,,,,,,,,,,,,,,Other,1635.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1422.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1422.57,1635.95, "ASST HARVEST VEIN,ASSISTANT SURGEON",35500,HCPCS,975,RC,80,,,both,317.75,222.43,,,,,,,,,,,,,,,,,,,Other,56.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,49.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,49.31,56.71, BP GRAFT VEIN ILIO AORTO MESENTRIC,35531,HCPCS,975,RC,,,,both,7328,5129.6,,,,,,,,,,,,,,,,,,,Other,2185.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1900.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1900.37,2185.42, HEPATORENAL BYPASS WITH VEIN,35535,HCPCS,975,RC,,,,both,7015,4910.5,,,,,,,,,,,,,,,,,,,Other,2132.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1854.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1854.69,2132.89, SPLENORENAL BYPASS WITH VEIN GRAFT,35536,HCPCS,975,RC,,,,both,6233,4363.1,,,,,,,,,,,,,,,,,,,Other,1893.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1646.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1646.2,1893.13, FEMORAL POPLITEAL BYPASS VEIN GRAFT 90G,35556,HCPCS,975,RC,,,,both,4921,3444.7,,,,,,,,,,,,,,,,,,,Other,1545.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1344.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1344.18,1545.8, "ASST FEM-POP BPG WITH VEIN,ASSISTANT SURGEON",35556,HCPCS,975,RC,80,,,both,1230,861,,,,,,,,,,,,,,,,,,,Other,247.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,215.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,215.07,247.33, FEM-FEM BYPASS GRAFT,35558,HCPCS,975,RC,,,,both,4629,3240.3,,,,,,,,,,,,,,,,,,,Other,1347.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1172.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1172.17,1347.99, AORTORENAL BYPASS,35560,HCPCS,975,RC,,,,both,6672,4670.4,,,,,,,,,,,,,,,,,,,Other,1910.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1661.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1661.41,1910.63, BYPASS GRAFT WITH VEIN ILIOFEMORAL,35565,HCPCS,975,RC,,,,both,5031,3521.7,,,,,,,,,,,,,,,,,,,Other,1428.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1242.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1242.06,1428.37, FEMORAL-DISTAL BYPASS WITH VEIN,35566,HCPCS,975,RC,,,,both,6239,4367.3,,,,,,,,,,,,,,,,,,,Other,1845.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1604.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1604.94,1845.67, "FEMORAL-DISTAL BYPASS WITH VEIN ASST,ASSISTANT SURGEON",35566,HCPCS,975,RC,80,,,both,1560,1092,,,,,,,,,,,,,,,,,,,Other,295.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,256.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,256.79,295.3, TIB-TIB BYPASS WITH VEIN 90,35570,HCPCS,975,RC,,,,both,5581,3906.7,,,,,,,,,,,,,,,,,,,Other,1650.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1435.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1435.42,1650.73, POP-TIB/PERONEAL/OTHER VESSEL BYPASS,35571,HCPCS,975,RC,,,,both,5062,3543.4,,,,,,,,,,,,,,,,,,,Other,1472.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1280.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1280.46,1472.53, VEIN HARVEST LOWER EXTR,35572,HCPCS,975,RC,,,,both,1267,886.9,,,,,,,,,,,,,,,,,,,Other,378.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,329.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,329.3,378.69, "ASST POP-TIB/PERONEAL/OTHER VESSEL BYPAS,ASSISTANT SURGEON",35571,HCPCS,975,RC,80,,,both,1266,886.2,,,,,,,,,,,,,,,,,,,Other,235.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,204.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,204.87,235.6, IN-SITU FEM-POP VEIN BYPASS,35583,HCPCS,975,RC,,,,both,5227,3658.9,,,,,,,,,,,,,,,,,,,Other,1596.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1388.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1388.57,1596.86, FEM TIB IN SITU VEIN BP,35585,HCPCS,975,RC,,,,both,5998,4198.6,,,,,,,,,,,,,,,,,,,Other,1852.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1610.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1610.62,1852.21, "ASST FEM TIB IN SITU VEIN BP,ASSISTANT SURGEON",35585,HCPCS,975,RC,80,,,both,1500,1050,,,,,,,,,,,,,,,,,,,Other,296.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,257.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,257.7,296.35, IN-SITU FEM-POP BPG WITH VEIN,35587,HCPCS,975,RC,,,,both,5159,3611.3,,,,,,,,,,,,,,,,,,,Other,1491,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1296.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1296.52,1491, CAROTID-SUBCLAVIAN BYPASS GRAFT,35606,HCPCS,975,RC,,,,both,4757,3329.9,,,,,,,,,,,,,,,,,,,Other,1303.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1133.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1133.62,1303.65, "ASST CAROTID-SUBCLAVIAN BYPASS GRAFT,ASSISTANT SURGEON",35606,HCPCS,975,RC,80,,,both,1189,832.3,,,,,,,,,,,,,,,,,,,Other,208.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,181.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,181.38,208.58, BPG AX-FEM W/GRAFT 90G,35621,HCPCS,975,RC,,,,both,4118,2882.6,,,,,,,,,,,,,,,,,,,Other,1213.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1055.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1055.54,1213.87, "ASST BPG AX-FEM W/GRAFT,ASSISTANT SURGEON",35621,HCPCS,975,RC,80,,,both,1030,721,,,,,,,,,,,,,,,,,,,Other,194.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,168.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,168.88,194.22, BYPASS GRAFT AORTOSUBCLAVIAN/CARTO,35626,HCPCS,975,RC,,,,both,6900,4830,,,,,,,,,,,,,,,,,,,Other,1789.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1556.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1556.31,1789.75, AORTO-MESENTRIC CELIAC RENAL BPG,35631,HCPCS,975,RC,,,,both,7734,5413.8,,,,,,,,,,,,,,,,,,,Other,2056.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1787.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1787.88,2056.07, SPLENO RENAL BYPASS GRAFT,35636,HCPCS,975,RC,,,,both,6177,4323.9,,,,,,,,,,,,,,,,,,,Other,1787.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1553.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1553.99,1787.09, BPG AORTO-ILIAC,35637,HCPCS,975,RC,,,,both,6318,4422.6,,,,,,,,,,,,,,,,,,,Other,1858.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1616.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1616.3,1858.75, BPG AORTO-BI-ILIAC,35638,HCPCS,975,RC,,,,both,6461,4522.7,,,,,,,,,,,,,,,,,,,Other,1936.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1684.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1684.22,1936.85, BYPASS GRAFT W/OTHER THAN VEIN CA,35642,HCPCS,975,RC,,,,both,3764,2634.8,,,,,,,,,,,,,,,,,,,Other,1107.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,962.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,962.61,1107.01, AORTOBIFEMORAL BYPASS W/GRAFT 90G,35646,HCPCS,975,RC,,,,both,6337,4435.9,,,,,,,,,,,,,,,,,,,Other,1893.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1646.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1646.11,1893.03, "ASST AORTOBIFEM BP W/GRAFT,ASSISTANT SURGEON",35646,HCPCS,975,RC,80,,,both,1584,1108.8,,,,,,,,,,,,,,,,,,,Other,302.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,263.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,263.38,302.88, AORTOFEMORAL BYPASS WITH GRAFT 90G,35647,HCPCS,975,RC,,,,both,5841,4088.7,,,,,,,,,,,,,,,,,,,Other,1674.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1456.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1456.46,1674.93, AXIL-FEM-FEM BPG OTHER THAN VEIN,35654,HCPCS,975,RC,,,,both,4966,3476.2,,,,,,,,,,,,,,,,,,,Other,1515.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1318.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1318.03,1515.74, "ASST AX-FEM-FEM BPG,ASSISTANT SURGEON",35654,HCPCS,975,RC,80,,,both,1242,869.4,,,,,,,,,,,,,,,,,,,Other,242.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,210.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,210.89,242.52, FEM-POP BYPASS GRAFT 90G,35656,HCPCS,975,RC,,,,both,3983,2788.1,,,,,,,,,,,,,,,,,,,Other,1189.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1034.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1034.37,1189.52, "ASST FEM-POP BYPASS W/GRAFT,ASSISTANT SURGEON",35656,HCPCS,975,RC,80,,,both,996,697.2,,,,,,,,,,,,,,,,,,,Other,190.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,165.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,165.5,190.33, FEMORAL-FEMORAL BYPASS GRAFT 90,35661,HCPCS,975,RC,,,,both,4111,2877.7,,,,,,,,,,,,,,,,,,,Other,1199.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1042.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1042.65,1199.05, "ASST FEMORAL-FEMORAL BYPASS GRAFT 90,ASSISTANT SURGEON",35661,HCPCS,975,RC,80,,,both,1028,719.6,,,,,,,,,,,,,,,,,,,Other,191.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,166.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,166.83,191.84, ILIOILIAC BYPASS GRAFT,35663,HCPCS,975,RC,,,,both,4751,3325.7,,,,,,,,,,,,,,,,,,,Other,1364.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1186.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1186.54,1364.52, BYPASS GRAFT ILIOFEMORAL 90G,35665,HCPCS,975,RC,,,,both,4438,3106.6,,,,,,,,,,,,,,,,,,,Other,1303.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1133.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1133.22,1303.2, BYPASS GRAFT FEM-ANT TIBIAL 90G,35666,HCPCS,975,RC,,,,both,4812,3368.4,,,,,,,,,,,,,,,,,,,Other,1421.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1235.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1235.8,1421.17, "ASST BYPASS GRAFT ILIOFEMORAL,ASSISTANT SURGEON",35665,HCPCS,975,RC,80,,,both,1110,777,,,,,,,,,,,,,,,,,,,Other,208.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,181.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,181.32,208.51, "ASST BYPASS GRAFT FEM-ANT TIBIAL,ASSISTANT SURGEON",35666,HCPCS,975,RC,80,,,both,1203,842.1,,,,,,,,,,,,,,,,,,,Other,227.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,197.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,197.72,227.39, BYPASS GRAFT COMPOSITE,35681,HCPCS,975,RC,,,,both,366,256.2,,,,,,,,,,,,,,,,,,,Other,88.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,77.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,77.2,88.79, "ASST BYPASS GRAFT COMPOSITE,ASSISTANT SURGEON",35681,HCPCS,975,RC,80,,,both,92,64.4,,,,,,,,,,,,,,,,,,,Other,14.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.35,14.21, BYPASS GRAFT AUTO COMPOSITE 2 VEIN,35682,HCPCS,975,RC,,,,both,1477,1033.9,,,,,,,,,,,,,,,,,,,Other,390.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,339.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,339.95,390.94, TRANSPOS/REIMPLAN;VERTEBRAL TO ART 90G,35691,HCPCS,975,RC,,,,both,4238,2966.6,,,,,,,,,,,,,,,,,,,Other,1058.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,920.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,920.8,1058.92, "ASST VERT ARTERY BYPASS,ASSISTANT SURGEON",35691,HCPCS,975,RC,80,,,both,1060,742,,,,,,,,,,,,,,,,,,,Other,169.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,147.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,147.32,169.42, TRANSPOSITION SUBCLAVIAN-CAROTID,35694,HCPCS,975,RC,,,,both,4343,3040.1,,,,,,,,,,,,,,,,,,,Other,1106.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,961.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,961.97,1106.26, REIMPLANTATION VISC ART TO INFRARENAL AO,35697,HCPCS,975,RC,,,,both,603,422.1,,,,,,,,,,,,,,,,,,,Other,163.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,141.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,141.92,163.21, "ASST REIMPLANTATION VISC ART TO INFRAREN,ASSISTANT SURGEON",35697,HCPCS,975,RC,80,,,both,151,105.7,,,,,,,,,,,,,,,,,,,Other,26.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,22.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,22.71,26.12, EXPLORATION CAROTID ARTERY 90G,35701,HCPCS,975,RC,,,,both,2347,1642.9,,,,,,,,,,,,,,,,,,,Other,450.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,391.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,391.56,450.29, "ASST RE-OP FEM-DISTAL BYPASS,ASSISTANT SURGEON",35700,HCPCS,975,RC,80,,,both,162,113.4,,,,,,,,,,,,,,,,,,,Other,27.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.58,27.12, EXPLORATION OF LOWER EXTREMITY COMMON FE,35703,HCPCS,975,RC,,,,both,1675,1172.5,,,,,,,,,,,,,,,,,,,Other,457.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,398.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,398.06,457.77, "ASST EXPLORATION OF LOWER EXTREMITY COMM,ASSISTANT SURGEON",35703,HCPCS,975,RC,80,,,both,419,293.3,,,,,,,,,,,,,,,,,,,Other,73.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,63.69,73.25, NECK EXPLORATION,35800,HCPCS,975,RC,,,,both,2386,1670.2,,,,,,,,,,,,,,,,,,,Other,776.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,674.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,674.83,776.05, EXPLORATION PO HEMORRHAGE/THROMBOSIS/INF,35820,HCPCS,975,RC,,,,both,7286,5100.2,,,,,,,,,,,,,,,,,,,Other,2258.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1963.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1963.96,2258.56, EXPL POST-OP HEMORRHAGE INFECTION THROMB,35840,HCPCS,975,RC,,,,both,4104,2872.8,,,,,,,,,,,,,,,,,,,Other,1344.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1169.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1169.45,1344.87, EXPLORATION POST-OP EXTREMITY,35860,HCPCS,975,RC,,,,both,2724,1906.8,,,,,,,,,,,,,,,,,,,Other,937.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,814.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,814.79,937.01, "ASST EXPL POST-OP HEM EXTREMITY,ASSISTANT SURGEON",35860,HCPCS,975,RC,80,,,both,681,476.7,,,,,,,,,,,,,,,,,,,Other,149.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,130.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,130.37,149.92, THROMBECT ART/VEIN GRAFT 90G,35875,HCPCS,975,RC,,,,both,2269,1588.3,,,,,,,,,,,,,,,,,,,Other,652.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,567.67,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,567.67,652.83, THROMBECTOMY OF ART/VEN GFT W/REVIS,35876,HCPCS,975,RC,,,,both,3483,2438.1,,,,,,,,,,,,,,,,,,,Other,1044.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,907.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,907.84,1044.02, REVISE LE BP W/O THRBCTMY W/ANGIOP,35879,HCPCS,975,RC,,,,both,3254,2277.8,,,,,,,,,,,,,,,,,,,Other,1026.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,892.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,892.75,1026.67, "REVISE LE BP W/O THRBCTMY W/ANGIOP ASST,ASSISTANT SURGEON",35879,HCPCS,975,RC,80,,,both,814,569.8,,,,,,,,,,,,,,,,,,,Other,164.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,142.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,142.84,164.27, REVISION LE ABP W/ VEIN INTERPOS 90,35881,HCPCS,975,RC,,,,both,3458,2420.6,,,,,,,,,,,,,,,,,,,Other,1139.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,991.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,991.2,1139.88, FEMORAL ANASTOMOSIS SYNTH ARTERIAL SYNTH,35883,HCPCS,975,RC,,,,both,4098,2868.6,,,,,,,,,,,,,,,,,,,Other,1329.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1155.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1155.87,1329.25, "ASST REVISION FEMORAL ANASTOMOSIS SYNTH,ASSISTANT SURGEON",35883,HCPCS,975,RC,80,,,both,1025,717.5,,,,,,,,,,,,,,,,,,,Other,212.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,184.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,184.94,212.68, EXCISION INFECTED GRAFT EXTREMITY,35903,HCPCS,975,RC,,,,both,2175,1522.5,,,,,,,,,,,,,,,,,,,Other,621.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,540.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,540.4,621.46, EXCIS OF INFECTED GRAFT; ABDOMEN,35907,HCPCS,975,RC,,,,both,7611,5327.7,,,,,,,,,,,,,,,,,,,Other,2118.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1841.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1841.85,2118.13, INTRO/NEEDLE OR INTRACATHETER VEIN,36000,HCPCS,975,RC,,,,both,107,74.9,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, INJ PSEUDOANEURYSM 00G,36002,HCPCS,975,RC,,,,both,526,368.2,,,,,,,,,,,,,,,,,,,Other,108.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,147.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,108.1,147.21, INJECTION CONTRAST VENOGRAPHY,36005,HCPCS,975,RC,,,,both,634,443.8,,,,,,,,,,,,,,,,,,,Other,49.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,224.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,49.91,224.81, INTRO CATH INF/SUP VENA CAV XXX,36010,HCPCS,975,RC,,,,both,1688,1181.6,,,,,,,,,,,,,,,,,,,Other,114.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,473.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,114.95,473.22, SELECTIVE CATH PLACEMENT VENOUS 1ST,36011,HCPCS,975,RC,,,,both,2643,1850.1,,,,,,,,,,,,,,,,,,,Other,163.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,719.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,163.8,719.81, CVC PLACEMENT SELECTIVE,36012,HCPCS,975,RC,,,,both,3026,2118.2,,,,,,,,,,,,,,,,,,,Other,184.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,746.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,184.47,746.15, RIGHT HEART CATHETERIZATION,36013,HCPCS,975,RC,,,,both,1070,749,,,,,,,,,,,,,,,,,,,Other,133.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,709.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,133.33,709.15, SELECT CATHETER PLACE LEFT OR RIGHT,36014,HCPCS,975,RC,,,,both,1018,712.6,,,,,,,,,,,,,,,,,,,Other,155.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,690.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,155.75,690.4, SELECTIVE CATHETER PLACEMENT SEGMEN,36015,HCPCS,975,RC,,,,both,1287,900.9,,,,,,,,,,,,,,,,,,,Other,176.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,730.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,176.47,730.84, INTRO CATH CAROTID OR VERTEBRAL,36100,HCPCS,975,RC,,,,both,1279,895.3,,,,,,,,,,,,,,,,,,,Other,164.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,484.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,164.57,484.99, INTRO CATH EXTREMITY ARTERY,36140,HCPCS,975,RC,,,,both,808,565.6,,,,,,,,,,,,,,,,,,,Other,95.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,459.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,95.8,459.86, INTRO CATH AORTIC TRANSLUMBAR,36160,HCPCS,975,RC,,,,both,1051,735.7,,,,,,,,,,,,,,,,,,,Other,126.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,502.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,126.84,502.69, INTRO CATH AORTA XXX,36200,HCPCS,975,RC,,,,both,1147,802.9,,,,,,,,,,,,,,,,,,,Other,150.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,527.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,150.49,527.73, CATH 1ST ORDER ARTERIAL,36215,HCPCS,975,RC,,,,both,3400,2380,,,,,,,,,,,,,,,,,,,Other,221.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,976.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,221.99,976.92, CATH 2ND ORDER ARTERIAL XXX,36216,HCPCS,975,RC,,,,both,2271,1589.7,,,,,,,,,,,,,,,,,,,Other,295.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1005.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,295.03,1005.46, CATH 3RD ORDER ARTERIAL,36217,HCPCS,975,RC,,,,both,2805,1963.5,,,,,,,,,,,,,,,,,,,Other,367.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1818.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,367.85,1818.02, SELEC CATH ADDTL 2ND 3RD + THOR,36218,HCPCS,975,RC,,,,both,532,372.4,,,,,,,,,,,,,,,,,,,Other,56.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,212.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,56.12,212.87, THORACIC AORTA W/CAROTID ANGIO-FLUS,36221,HCPCS,975,RC,,,,both,1816,1271.2,,,,,,,,,,,,,,,,,,,Other,217.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,882.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,217.72,882.65, ANGIO SEL CC/INOM UNI,36222,HCPCS,975,RC,,,,both,2000,1400,,,,,,,,,,,,,,,,,,,Other,308.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1169.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,308.74,1169.5, ANGIO CCA UNI W/CEREB,36223,HCPCS,975,RC,,,,both,2217,1551.9,,,,,,,,,,,,,,,,,,,Other,366.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1766.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,366.08,1766.27, S-I-SELECT W VERTEBRAL ANGIO UNILAT,36225,HCPCS,975,RC,,,,both,2175,1522.5,,,,,,,,,,,,,,,,,,,Other,362.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1655.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,362.5,1655.57, ANGIO VERT UNI,36226,HCPCS,975,RC,,,,both,260,182,,,,,,,,,,,,,,,,,,,Other,405.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,254.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,254.8,405.79, CATH ABDM PELV LOWER EXT 1ST ORDER,36245,HCPCS,975,RC,,,,both,1706,1194.2,,,,,,,,,,,,,,,,,,,Other,248.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1103.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,248.96,1103.77, CATH ABDOMINAL 2ND ORDER,36246,HCPCS,975,RC,,,,both,1938,1356.6,,,,,,,,,,,,,,,,,,,Other,269.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,750.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,269.57,750.22, SELECTIVE ABDOM PELV LOW EXTR XXX,36247,HCPCS,975,RC,,,,both,2555,1788.5,,,,,,,,,,,,,,,,,,,Other,309.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1251.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,309.87,1251.18, ADDITIONAL ABDOM PELV OR LOWER EXTR,36248,HCPCS,975,RC,,,,both,403,282.1,,,,,,,,,,,,,,,,,,,Other,48.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,105.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.76,105.76, RENAL AORTOG SELECTIVE INCLUDES S/I,36251,HCPCS,975,RC,,,,both,1713,1199.1,,,,,,,,,,,,,,,,,,,Other,270.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1131.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,270.47,1131.45, RENAL AORTOG BILAT SELECTIVE W S/I,36252,HCPCS,975,RC,,,,both,2705,1893.5,,,,,,,,,,,,,,,,,,,Other,376.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1252.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,376.32,1252.18, ANGIO RENAL SUPERSEL CATH 1 OR MORE,36253,HCPCS,975,RC,,,,both,2396,1677.2,,,,,,,,,,,,,,,,,,,Other,358.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1736.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,358.62,1736.78, ANGIO RENAL BILAT SUPERSELCT 1 OR M,36254,HCPCS,975,RC,,,,both,2302,1611.4,,,,,,,,,,,,,,,,,,,Other,440.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1767.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,440.44,1767.57, IV ACCESS,36410,HCPCS,975,RC,,,,both,48,33.6,,,,,,,,,,,,,,,,,,,Other,9.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.33,17.97, BLOOD DRAW VENIPUNCTURE,36415,HCPCS,300,RC,,,,both,21,14.7,,,,,,,,,,,,,,,,,,,Other,4.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,4.53,9.15, VENIPUNCTURE CUTDOWN; OVER 1YR,36425,HCPCS,975,RC,,,,both,106,74.2,,,,,,,,,,,,,,,,,,,Other,38.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,33.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,33.6,38.64, INJ S/MULT SPIDER VEINS,36468,HCPCS,975,RC,,,,both,409,286.3,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, INJ SCLEROSING AGENT SINGLE VEIN 10,36470,HCPCS,975,RC,,,,both,427,298.9,,,,,,,,,,,,,,,,,,,Other,40.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,40.78,113.45, INJ SCLEROSG SOLN MUTIPLE VEINS 10G,36471,HCPCS,975,RC,,,,both,587,410.9,,,,,,,,,,,,,,,,,,,Other,80.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,193.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,80.61,193.82, MOCA MECHANOCHEMICAL ABLATION EXTREMITY,36473,HCPCS,975,RC,,,,both,5172,3620.4,,,,,,,,,,,,,,,,,,,Other,192.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1076.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,192.42,1076.13, ABLATION ENDOVASCULAR ADDT VEIN,36474,HCPCS,975,RC,,,,both,1058,740.6,,,,,,,,,,,,,,,,,,,Other,95.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,228.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,95.32,228.12, RF RADIO-FREQUENCY ABLATION 1ST VEIN,36475,HCPCS,975,RC,,,,both,5349,3744.3,,,,,,,,,,,,,,,,,,,Other,298.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,984.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,298.7,984.16, SELECTIVE VENOUS BLOOD SAMPLE CATH,36500,HCPCS,975,RC,,,,both,727,508.9,,,,,,,,,,,,,,,,,,,Other,192.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,167.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,167.44,192.56, CVP <5 YRS OLD,36555,HCPCS,975,RC,,,,both,848,593.6,,,,,,,,,,,,,,,,,,,Other,91.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,199.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,91.52,199.72, CVP CENTRAL LINE VENOUS CATH >5YRS,36556,HCPCS,975,RC,,,,both,837,585.9,,,,,,,,,,,,,,,,,,,Other,90.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,222.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,90.96,222.55, CVC TUNNELED W/O PORT/PUMP G10,36558,HCPCS,975,RC,,,,both,1875,1312.5,,,,,,,,,,,,,,,,,,,Other,269.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,731.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,269.53,731.07, MEDIPORT SUBCLAVIAN 10G,36561,HCPCS,975,RC,,,,both,2718,1902.6,,,,,,,,,,,,,,,,,,,Other,350.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,897.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,350.37,897.59, "ASST MEDIPORT SUBCLAVIAN,ASSISTANT SURGEON",36561,HCPCS,975,RC,80,,,both,680,476,,,,,,,,,,,,,,,,,,,Other,56.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,143.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,56.06,143.62, PICC LINE PLACEMENT 00G,36569,HCPCS,975,RC,,,,both,654,457.8,,,,,,,,,,,,,,,,,,,Other,102.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,89.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,89.4,102.8, MEDIPORT FORE-ARM 10G,36571,HCPCS,975,RC,,,,both,3246,2272.2,,,,,,,,,,,,,,,,,,,Other,344.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1236.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,344.86,1236.78, INSERTION OF PICC LINE W/GUIDANCE,36573,HCPCS,975,RC,,,,both,508,355.6,,,,,,,,,,,,,,,,,,,Other,84.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,335.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,84.07,335.8, REPAIR CENTR VENOUS ACCESS DEVICE,36575,HCPCS,975,RC,,,,both,516,361.2,,,,,,,,,,,,,,,,,,,Other,34.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,135.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.43,135.44, REPLACE CATHETER ONLY CNTRL VENOUS ACCES,36578,HCPCS,975,RC,,,,both,975,682.5,,,,,,,,,,,,,,,,,,,Other,220.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,413.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,220.94,413.27, PICC LINE REPLACEMENT,36580,HCPCS,975,RC,,,,both,562,393.4,,,,,,,,,,,,,,,,,,,Other,67.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,180.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,67.71,180.21, CVC REPLACEMENT SAME LOC CENTRAL,36581,HCPCS,975,RC,,,,both,1615,1130.5,,,,,,,,,,,,,,,,,,,Other,190.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,696.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,190.27,696.21, PICC LINE REPLACEMENT,36584,HCPCS,975,RC,,,,both,504,352.8,,,,,,,,,,,,,,,,,,,Other,59.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,281.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,59.25,281.34, REMOVAL CVC W/O PORT/PUMP 10G,36589,HCPCS,975,RC,,,,both,627,438.9,,,,,,,,,,,,,,,,,,,Other,144.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,162.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,144.72,162.59, MEDIPORT REMOV SUBCLAV OR ARM 10,36590,HCPCS,975,RC,,,,both,978,684.6,,,,,,,,,,,,,,,,,,,Other,200.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,221.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,200.54,221.3, MEDIPORT THROMBOLYSIS,36593,HCPCS,975,RC,,,,both,119,83.3,,,,,,,,,,,,,,,,,,,Other,39.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.5,39.67, CVC REPOSITION,36597,HCPCS,975,RC,,,,both,352,246.4,,,,,,,,,,,,,,,,,,,Other,61.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,107.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,61.15,107.56, MEDIPORT VENOGRAPHY,36598,HCPCS,975,RC,,,,both,384,268.8,,,,,,,,,,,,,,,,,,,Other,35.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,107.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,35.34,107.24, ARTERIAL PUNCTURE W BLOOD DRAW,36600,HCPCS,975,RC,,,,both,108,75.6,,,,,,,,,,,,,,,,,,,Other,14.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,25.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.91,25.81, ARTERIAL LINE CATHETERIZATION 00G,36620,HCPCS,975,RC,,,,both,440,308,,,,,,,,,,,,,,,,,,,Other,47.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,40.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,40.95,47.1, ARTERIAL CUTDOWN PERCUT MONITORING,36625,HCPCS,975,RC,,,,both,467,326.9,,,,,,,,,,,,,,,,,,,Other,113.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,98.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,98.36,113.12, DIALYSIS CATH PLACEMENT,36800,HCPCS,975,RC,,,,both,568,397.6,,,,,,,,,,,,,,,,,,,Other,125.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,108.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,108.72,125.03, AV ANASTOMOSIS OPEN ARM/CEPH TRANS,36818,HCPCS,975,RC,,,,both,2403,1682.1,,,,,,,,,,,,,,,,,,,Other,761,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,661.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,661.74,761, "ASST AV ANASTOMOSIS OPEN ARM CEPH TRANS,ASSISTANT SURGEON",36818,HCPCS,975,RC,80,,,both,600,420,,,,,,,,,,,,,,,,,,,Other,121.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,105.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,105.88,121.76, AV ANAST OPEN UP/ARM BASIL VEIN 90G,36819,HCPCS,975,RC,,,,both,2765,1935.5,,,,,,,,,,,,,,,,,,,Other,806.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,701.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,701.15,806.32, AV FUSION/FOREARM VEIN 90G,36820,HCPCS,975,RC,,,,both,2786,1950.2,,,,,,,,,,,,,,,,,,,Other,803.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,699.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,699.03,803.89, ARTERIOVENOUS ANASTOMOSIS DIRECT,36821,HCPCS,975,RC,,,,both,2476,1733.2,,,,,,,,,,,,,,,,,,,Other,728.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,633.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,633.43,728.44, "AV FUSION/FOREARM VEIN ASSIST,ASSISTANT SURGEON",36820,HCPCS,975,RC,80,,,both,697,487.9,,,,,,,,,,,,,,,,,,,Other,128.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,111.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,111.85,128.62, "ASST ARTERIOVENOUS ANASTOMOSIS DIRECT,ASSISTANT SURGEON",36821,HCPCS,975,RC,80,,,both,607,424.9,,,,,,,,,,,,,,,,,,,Other,116.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,101.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,101.35,116.55, AV FISTULA CREATION,36825,HCPCS,975,RC,,,,both,2541,1778.7,,,,,,,,,,,,,,,,,,,Other,874.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,760.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,760.11,874.12, AV FISTULA NONAUTOGENOUS GRAFT 90G,36830,HCPCS,975,RC,,,,both,2622,1835.4,,,,,,,,,,,,,,,,,,,Other,736.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,640.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,640.55,736.63, AV FISTULA OPEN REVISION 90G,36832,HCPCS,975,RC,,,,both,2467,1726.9,,,,,,,,,,,,,,,,,,,Other,832.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,724.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,724.04,832.65, "ASST AV FISTULA OPEN REVISION,ASSISTANT SURGEON",36832,HCPCS,975,RC,80,,,both,617,431.9,,,,,,,,,,,,,,,,,,,Other,133.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,115.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,115.85,133.22, AV FISTULA REVISE OPEN W/THROMB 90,36833,HCPCS,975,RC,,,,both,2580,1806,,,,,,,,,,,,,,,,,,,Other,892.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,776.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,776.04,892.45, DRIL PROCEDURE FOR STEAL SYDR 90G,36838,HCPCS,975,RC,,,,both,3945,2761.5,,,,,,,,,,,,,,,,,,,Other,1261.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1096.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1096.86,1261.4, AVF/GRAFT DIAGNOSTIC ANGIO,36901,HCPCS,975,RC,,,,both,1954,1367.8,,,,,,,,,,,,,,,,,,,Other,174.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,634.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,174.78,634.33, PTA AVF GRAFT,36902,HCPCS,975,RC,,,,both,4028,2819.6,,,,,,,,,,,,,,,,,,,Other,249.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1094.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,249.21,1094.14, STENT AVF/GRAFT INC PTA,36903,HCPCS,975,RC,,,,both,16199,11339.3,,,,,,,,,,,,,,,,,,,Other,331.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,4336.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,331.2,4336.54, THROMB SECONDARY,37186,HCPCS,975,RC,,,,both,2277,1593.9,,,,,,,,,,,,,,,,,,,Other,265.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1071.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,265.74,1071.74, GREENFIELD VENA CAVA FILTER 00G,37191,HCPCS,975,RC,,,,both,1974,1381.8,,,,,,,,,,,,,,,,,,,Other,226.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1712.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,226.5,1712.72, THROMBOLYSIS ART NON-CORONARY,37211,HCPCS,975,RC,,,,both,1494,1045.8,,,,,,,,,,,,,,,,,,,Other,409.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,356.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,356.18,409.61, VENOUS INFUSION LYSIS INITIAL DAY,37212,HCPCS,975,RC,,,,both,1297,907.9,,,,,,,,,,,,,,,,,,,Other,354.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,308.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,308.24,354.48, THROMBOLYSIS CONTIN SUBSEQ ESCHANGE,37213,HCPCS,975,RC,,,,both,939,657.3,,,,,,,,,,,,,,,,,,,Other,244.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,212.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,212.38,244.24, THROMBOLYSIS CESSATION FINAL DAY,37214,HCPCS,975,RC,,,,both,518,362.6,,,,,,,,,,,,,,,,,,,Other,129.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,112.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,112.85,129.77, CAROTID STENT TRANSCATH W/PROTEC 90,37215,HCPCS,975,RC,,,,both,3962,2773.4,,,,,,,,,,,,,,,,,,,Other,1084.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,943.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,943.44,1084.95, STENT CCA/INOM RETRO 90,37217,HCPCS,975,RC,,,,both,4231,2961.7,,,,,,,,,,,,,,,,,,,Other,1195.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1039.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1039.62,1195.57, UPPER STENT PTA INITIAL ARTERY,37236,HCPCS,975,RC,,,,both,10591,7413.7,,,,,,,,,,,,,,,,,,,Other,477.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2391.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,477.55,2391.87, STENT RENAL/MES EACH ADDITIONAL ARTERY,37237,HCPCS,975,RC,,,,both,6179,4325.3,,,,,,,,,,,,,,,,,,,Other,231.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1121.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,231.17,1121.18, STENT PLACEMENT VEIN INITIAL,37238,HCPCS,975,RC,,,,both,11938,8356.6,,,,,,,,,,,,,,,,,,,Other,328.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2973.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,328.35,2973.09, VASC EMBOLIZATION OR OCCLUSION VENOUS OT,37241,HCPCS,975,RC,,,,both,12279,8595.3,,,,,,,,,,,,,,,,,,,Other,440.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3982.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,440.83,3982.1, EMBOLIZATION ARTERIAL,37242,HCPCS,975,RC,,,,both,24537,17175.9,,,,,,,,,,,,,,,,,,,Other,493,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6031.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,493,6031.25, TRANSLUMINAL BALLOON ANGIOPLASTY INITIAL,37246,HCPCS,975,RC,,,,both,6364,4454.8,,,,,,,,,,,,,,,,,,,Other,372.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1610.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,372.37,1610.65, TRANSLUMINAL BALLOON ANGIOPLASTY INITIAL,37248,HCPCS,975,RC,,,,both,4670,3269,,,,,,,,,,,,,,,,,,,Other,309.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1204.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,309.64,1204.36, LIGATION BANDING ANGIOACCESS AVF,37607,HCPCS,975,RC,,,,both,1393,975.1,,,,,,,,,,,,,,,,,,,Other,412.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,358.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,358.44,412.21, TEMPORAL ARTERY LIG/BX 10G,37609,HCPCS,975,RC,,,,both,999,699.3,,,,,,,,,,,,,,,,,,,Other,219.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,304.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,219.12,304.7, LIGATION ARTERY ABDOMEN,37617,HCPCS,975,RC,,,,both,4891,3423.7,,,,,,,,,,,,,,,,,,,Other,1449.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1260.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1260.53,1449.62, LIGATION ARTERY EXTREMITY,37618,HCPCS,975,RC,,,,both,1588,1111.6,,,,,,,,,,,,,,,,,,,Other,434.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,377.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,377.49,434.11, LIGATION OF FEM VEIN PART OR COMPLT,37650,HCPCS,975,RC,,,,both,1665,1165.5,,,,,,,,,,,,,,,,,,,Other,514.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,447.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,447.42,514.53, LIGATION SAPHENOUS VEIN UPPER LEG 90G,37700,HCPCS,975,RC,,,,both,963,674.1,,,,,,,,,,,,,,,,,,,Other,269.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,234.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,234.62,269.81, SAPH VEIN STRIPPING LESSER 90 G,37718,HCPCS,975,RC,,,,both,1665,1165.5,,,,,,,,,,,,,,,,,,,Other,439.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,381.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,381.79,439.06, "ASST SAPH VEIN STRIPPING LESSER,ASSISTANT SURGEON",37718,HCPCS,975,RC,80,,,both,416,291.2,,,,,,,,,,,,,,,,,,,Other,70.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,61.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,61.08,70.25, SAPHENOUS LONG VEIN STRIPPING 90G,37722,HCPCS,975,RC,,,,both,1760,1232,,,,,,,,,,,,,,,,,,,Other,512.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,445.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,445.62,512.46, LIG/DIV LONG/SHORT SAPH 90,37735,HCPCS,975,RC,,,,both,2190,1533,,,,,,,,,,,,,,,,,,,Other,651.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,566.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,566.39,651.35, LIGATION PERFORATORS,37760,HCPCS,975,RC,,,,both,2479,1735.3,,,,,,,,,,,,,,,,,,,Other,644.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,560.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,560.63,644.72, LIGATION PERFORATOR VEINS SUBFAS 90,37761,HCPCS,975,RC,,,,both,2007,1404.9,,,,,,,,,,,,,,,,,,,Other,585.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,508.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,508.9,585.24, STAB PHLEBECTOMY AVULSIONS/LEG (10-20) 1,37765,HCPCS,975,RC,,,,both,1890,1323,,,,,,,,,,,,,,,,,,,Other,294.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,407.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,294.6,407.09, STAB PHLEB >20,37766,HCPCS,975,RC,,,,both,2267,1586.9,,,,,,,,,,,,,,,,,,,Other,363.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,486.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,363.02,486.61, LIGATION DIV OF SHORT SAPHEN VEIN,37780,HCPCS,975,RC,,,,both,976,683.2,,,,,,,,,,,,,,,,,,,Other,263.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,229.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,229.52,263.94, LIG/DIV/ESC VEIN CLUSTERS/LEG 90G,37785,HCPCS,975,RC,,,,both,1227,858.9,,,,,,,,,,,,,,,,,,,Other,276.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,333.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,276.95,333.77, SPLENECTOMY,38100,HCPCS,975,RC,,,,both,4199,2939.3,,,,,,,,,,,,,,,,,,,Other,1284.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1117.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1117.21,1284.79, "ASST SPLENECTOMY,ASSISTANT SURGEON",38100,HCPCS,975,RC,80,,,both,1050,735,,,,,,,,,,,,,,,,,,,Other,205.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,178.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,178.75,205.56, EXCIS SPLN;TOTAL EN BLOC EXT DISEA,38102,HCPCS,975,RC,,,,both,1206,844.2,,,,,,,,,,,,,,,,,,,Other,285.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,248.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,248.63,285.92, SPLENORRHAPHY,38115,HCPCS,975,RC,,,,both,4255,2978.5,,,,,,,,,,,,,,,,,,,Other,1445.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1257.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1257.28,1445.87, SPLEEN UNLISTED LAPAROSCOPIC #,38129,HCPCS,975,RC,,,,both,2200,1540,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, "ASST SPLEEN UNLISTED LAPAROSCOPIC,ASSISTANT SURGEON",38129,HCPCS,975,RC,80,,,both,725,507.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, BONE MARROW ASPIRATION,38220,HCPCS,975,RC,,,,both,594,415.8,,,,,,,,,,,,,,,,,,,Other,63.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,155.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,63.09,155.27, BONE MARROW BX/NEEDLE/TROCHAR XX,38221,HCPCS,975,RC,,,,both,568,397.6,,,,,,,,,,,,,,,,,,,Other,66.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,155.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,66.25,155.33, BONE MARROW BIOPSY(IES) AND ASPIRATION(S,38222,HCPCS,975,RC,,,,both,571,399.7,,,,,,,,,,,,,,,,,,,Other,72.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,165.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.04,165.14, EXCISION DRAIN LYMPHOCELE/ CYST,38300,HCPCS,975,RC,,,,both,811,567.7,,,,,,,,,,,,,,,,,,,Other,244.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,358.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,244.81,358.13, LYMPH CHANNEL EXPLORATION OR OTH 90,38308,HCPCS,975,RC,,,,both,1707,1194.9,,,,,,,,,,,,,,,,,,,Other,519.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,451.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,451.5,519.22, EXC OR BX OF LYMPH NODE 10G,38500,HCPCS,975,RC,,,,both,980,686,,,,,,,,,,,,,,,,,,,Other,286.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,360.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,286.74,360.22, "ASST BX LYMPH NODE(S) OPEN,ASSISTANT SURGEON",38500,HCPCS,975,RC,80,,,both,245,171.5,,,,,,,,,,,,,,,,,,,Other,45.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,57.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,45.88,57.63, BX BY NEEDLE OF LYMPH NODE 00G,38505,HCPCS,975,RC,,,,both,451,315.7,,,,,,,,,,,,,,,,,,,Other,86.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,160.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,86.22,160.45, BX/EXC DEEP CERVICAL NODES NA 10G,38510,HCPCS,975,RC,,,,both,1684,1178.8,,,,,,,,,,,,,,,,,,,Other,441.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,538.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,441.64,538.83, EXC BX DEEP CERV NODE W EXC FAT PAD 90G,38520,HCPCS,975,RC,,,,both,1593,1115.1,,,,,,,,,,,,,,,,,,,Other,512.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,445.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,445.69,512.55, AXILLA EXCIS LYMPH NODE(S) DEEP 90G,38525,HCPCS,975,RC,,,,both,1506,1054.2,,,,,,,,,,,,,,,,,,,Other,502.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,437.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,437.32,502.93, "ASST AXILLA EXCIS LYMPH NODE(S) DEEP 90G,ASSISTANT SURGEON",38525,HCPCS,975,RC,80,,,both,377,263.9,,,,,,,,,,,,,,,,,,,Other,80.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,69.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,69.97,80.47, BIOPSY OR EXCISION OF INTERNAL MAMMARY N,38530,HCPCS,975,RC,,,,both,2317,1621.9,,,,,,,,,,,,,,,,,,,Other,614.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,534.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,534.62,614.81, OPEN BX/EXCISION OF LYMPH NODE(S); INGUI,38531,HCPCS,975,RC,,,,both,1545,1081.5,,,,,,,,,,,,,,,,,,,Other,506.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,440.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,440.4,506.46, "ASST BIOPSY OR EXC OF INTERNAL MAMMARY N,ASSISTANT SURGEON",38530,HCPCS,975,RC,80,,,both,579,405.3,,,,,,,,,,,,,,,,,,,Other,98.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,85.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,85.53,98.37, "ASST OPEN BX/EXC OF LYMPH NODE(S); INGUI,ASSISTANT SURGEON",38531,HCPCS,975,RC,80,,,both,386,270.2,,,,,,,,,,,,,,,,,,,Other,81.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,70.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,70.46,81.04, DISSECT EXCIS DEEP JUG NODE 90G,38542,HCPCS,975,RC,,,,both,1800,1260,,,,,,,,,,,,,,,,,,,Other,541.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,470.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,470.56,541.14, RETROPERITONEAL NODE DISSECTION,38562,HCPCS,975,RC,,,,both,2606,1824.2,,,,,,,,,,,,,,,,,,,Other,779.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,677.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,677.77,779.43, LYMPHADENECTOMY LIMITED RETROPERITO,38564,HCPCS,975,RC,,,,both,2780,1946,,,,,,,,,,,,,,,,,,,Other,778.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,676.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,676.79,778.31, "LYMPHADENECTOMY LIMITED RETROPERITO ASST,ASSISTANT SURGEON",38564,HCPCS,975,RC,80,,,both,695,486.5,,,,,,,,,,,,,,,,,,,Other,124.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,108.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,108.29,124.53, LAPS SURG RETROPERITONEAL LYMPH NODE BX,38570,HCPCS,975,RC,,,,both,2191,1533.7,,,,,,,,,,,,,,,,,,,Other,564,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,490.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,490.43,564, "ASST LAPS RETROPERITONEAL LYMPH NODE BX,ASSISTANT SURGEON",38570,HCPCS,975,RC,80,,,both,548,383.6,,,,,,,,,,,,,,,,,,,Other,90.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,78.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,78.47,90.24, AXIL LYMPHADENECTOMY SUPERFICIAL,38740,HCPCS,975,RC,,,,both,2389,1672.3,,,,,,,,,,,,,,,,,,,Other,792.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,689.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,689.51,792.94, COMPLETE AXILLARY LYMPHADENECTOMY,38745,HCPCS,975,RC,,,,both,3085,2159.5,,,,,,,,,,,,,,,,,,,Other,992.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,862.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,862.66,992.06, ABD LYMPHADENECTOMY REGIONAL,38747,HCPCS,975,RC,,,,both,1181,826.7,,,,,,,,,,,,,,,,,,,Other,291.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,253.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,253.15,291.13, INGUINOFEM LYMPH SUPERFICIAL 90G,38760,HCPCS,975,RC,,,,both,3161,2212.7,,,,,,,,,,,,,,,,,,,Other,918.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,798.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,798.57,918.36, PELVIC LYMPHADENECTOMY W/EXT ILIAC,38770,HCPCS,975,RC,,,,both,3437,2405.9,,,,,,,,,,,,,,,,,,,Other,861.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,749.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,749.55,861.99, "ASST PELVIC LYMPHADENECTOMY W/EXT ILIAC,ASSISTANT SURGEON",38770,HCPCS,975,RC,80,,,both,859,601.3,,,,,,,,,,,,,,,,,,,Other,137.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,119.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,119.93,137.92, INJECTION FOR LYMPHANGIOGRAPHY,38790,HCPCS,975,RC,,,,both,435,304.5,,,,,,,,,,,,,,,,,,,Other,87.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,75.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,75.69,87.03, SENTINEL NODE INJECTION IDENTIFICAT,38792,HCPCS,975,RC,,,,both,228,159.6,,,,,,,,,,,,,,,,,,,Other,31.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,76.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.96,76.8, SENT NODE INTRAOP ID OF SENT NODE,38900,HCPCS,975,RC,,,,both,518,362.6,,,,,,,,,,,,,,,,,,,Other,148.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,149.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,148.9,149.2, "ASST ID OF SENT NODE,ASSISTANT SURGEON",38900,HCPCS,975,RC,80,,,both,130,91,,,,,,,,,,,,,,,,,,,Other,23.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.82,23.87, MEDIASTINOTOMY TRANS THORACIC,39010,HCPCS,975,RC,,,,both,3145,2201.5,,,,,,,,,,,,,,,,,,,Other,903.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,785.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,785.41,903.23, REPAIR LACERATION DIAPHRAGM,39501,HCPCS,975,RC,,,,both,3322,2325.4,,,,,,,,,,,,,,,,,,,Other,959.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,833.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,833.95,959.05, REPAIR HH HERNIA TRAUMATIC THOR/ABD,39540,HCPCS,975,RC,,,,both,3328,2329.6,,,,,,,,,,,,,,,,,,,Other,976.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,849.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,849.46,976.88, DIAPH HERNIA REPAIR TRAUMATIC CHRON,39541,HCPCS,975,RC,,,,both,3554,2487.8,,,,,,,,,,,,,,,,,,,Other,1061.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,923.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,923.07,1061.54, DIAPHRAGM RESECTION COMPLEX REPAIR,39561,HCPCS,975,RC,,,,both,5948,4163.6,,,,,,,,,,,,,,,,,,,Other,1438.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1250.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1250.65,1438.25, BIOPSY OF LIP,40490,HCPCS,975,RC,,,,both,300,210,,,,,,,,,,,,,,,,,,,Other,64.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,64.56,113.53, EXC LIP TRANSVERSE WEDGE EXC W/PRIM CLOS,40510,HCPCS,975,RC,,,,both,1547,1082.9,,,,,,,,,,,,,,,,,,,Other,358.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,473.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,358.77,473.95, V EXCISION W/PRIMARY DIR LINEAR CLO,40520,HCPCS,975,RC,,,,both,1505,1053.5,,,,,,,,,,,,,,,,,,,Other,369.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,493.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,369.37,493.33, LIP REPAIR VERMILLION ONLY,40650,HCPCS,975,RC,,,,both,1789,1252.3,,,,,,,,,,,,,,,,,,,Other,391.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,541.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,391.98,541.08, CHEILOPLASTY UP TO 1/2 HT,40652,HCPCS,975,RC,,,,both,1684,1178.8,,,,,,,,,,,,,,,,,,,Other,406.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,542.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,406.76,542.28, REPAIR LIP 1/2 VERTICAL HT COMPLEX,40654,HCPCS,975,RC,,,,both,2005,1403.5,,,,,,,,,,,,,,,,,,,Other,445.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,585.19,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,445.1,585.19, BX VESTIBULE OF MOUTH G10,40808,HCPCS,975,RC,,,,both,546,382.2,,,,,,,,,,,,,,,,,,,Other,91.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,156.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,91.66,156.2, EXC LES MOUTH W/SIMPLE REPAIR 10G,40812,HCPCS,975,RC,,,,both,765,535.5,,,,,,,,,,,,,,,,,,,Other,187.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,264.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,187.88,264.38, EXCISION LESION MUCOSA VESTIBULE MOUTH W,40814,HCPCS,975,RC,,,,both,1134,793.8,,,,,,,,,,,,,,,,,,,Other,294.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,361.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,294.2,361.01, FRENULECTOMY,40819,HCPCS,975,RC,,,,both,864,604.8,,,,,,,,,,,,,,,,,,,Other,208.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,260.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,208.81,260.46, INCISION OF LINGUAL FRENUM,41010,HCPCS,975,RC,,,,both,611,427.7,,,,,,,,,,,,,,,,,,,Other,112.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,195.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,112.95,195.06, TONGUE BIOPSY ANTERIOR 2/3 G10,41100,HCPCS,975,RC,,,,both,542,379.4,,,,,,,,,,,,,,,,,,,Other,109.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,176.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,109.52,176.22, BIOPSY FLOOR OF MOUTH,41108,HCPCS,975,RC,,,,both,473,331.1,,,,,,,,,,,,,,,,,,,Other,93.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,158.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,93.78,158.36, EXCISION LESION TONGUE 90G,41112,HCPCS,975,RC,,,,both,997,697.9,,,,,,,,,,,,,,,,,,,Other,250.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,322.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,250.66,322.26, FRENECTOMY,41115,HCPCS,975,RC,,,,both,676,473.2,,,,,,,,,,,,,,,,,,,Other,148.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,239.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,148.98,239.22, REPAIR LACERATION MOUTH/ TONGUE,41250,HCPCS,975,RC,,,,both,988,691.6,,,,,,,,,,,,,,,,,,,Other,188.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,315.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,188.03,315.62, TONGUE LACERATION REPAIR >2.6,41252,HCPCS,975,RC,,,,both,1302,911.4,,,,,,,,,,,,,,,,,,,Other,222.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,327.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,222.91,327.12, GINGIVECTOMY EACH QUADRANT,41820,HCPCS,975,RC,,,,both,987,690.9,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, BIOPSY OF PALATE OR UVULA,42100,HCPCS,975,RC,,,,both,540,378,,,,,,,,,,,,,,,,,,,Other,113.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,141.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.24,141.81, EXCISION LESION OF PALATE UVULA,42104,HCPCS,975,RC,,,,both,684,478.8,,,,,,,,,,,,,,,,,,,Other,136.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,204.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.92,204.83, EXC RESECTN OF PALATE OR EXT OF LES,42140,HCPCS,975,RC,,,,both,737,515.9,,,,,,,,,,,,,,,,,,,Other,167.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,282.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,167.44,282.48, SALIVARY GLAND NEEDLE BIOPSY 00,42400,HCPCS,975,RC,,,,both,347,242.9,,,,,,,,,,,,,,,,,,,Other,53.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,88.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,53.59,88.44, BX SALIVARY GLAND INCISIONAL,42405,HCPCS,975,RC,,,,both,931,651.7,,,,,,,,,,,,,,,,,,,Other,229.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,293.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,229.85,293.72, EXC OF PAROTID TUMOR/GLAND;LATERAL,42410,HCPCS,975,RC,,,,both,2218,1552.6,,,,,,,,,,,,,,,,,,,Other,639.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,555.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,555.9,639.29, SUP PAROTIDECTOMY PRESERVE FAC NRV,42415,HCPCS,975,RC,,,,both,4240,2968,,,,,,,,,,,,,,,,,,,Other,1063.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,924.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,924.38,1063.05, "ASST SUP PAROTIDECTOMY PRESERVE FACIAL N,ASSISTANT SURGEON",42415,HCPCS,975,RC,80,,,both,1060,742,,,,,,,,,,,,,,,,,,,Other,170.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,147.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,147.9,170.09, EXC SUBMANDIBULAR GLAND 90G,42440,HCPCS,975,RC,,,,both,1880,1316,,,,,,,,,,,,,,,,,,,Other,422.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,367.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,367.42,422.54, INJECTION FOR SIALOGRAPHY,42550,HCPCS,975,RC,,,,both,407,284.9,,,,,,,,,,,,,,,,,,,Other,60.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,137.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.54,137.52, SALIVARY DUCT D AND C W/WO INJEC 00,42660,HCPCS,975,RC,,,,both,411,287.7,,,,,,,,,,,,,,,,,,,Other,79.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,97.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,79.69,97.98, BX OROPHARYNX,42800,HCPCS,975,RC,,,,both,513,359.1,,,,,,,,,,,,,,,,,,,Other,119.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,151.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,119.01,151.3, PHARYNX LESION EXCISION,42808,HCPCS,975,RC,,,,both,805,563.5,,,,,,,,,,,,,,,,,,,Other,168.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,223.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,168.66,223.76, EXC BRANCHIAL CLEFT CYST SKIN/SUBQ,42810,HCPCS,975,RC,,,,both,1089,762.3,,,,,,,,,,,,,,,,,,,Other,287.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,364.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,287.62,364.87, EXC BRACHIAL CLEFT CYST DEEP 90G,42815,HCPCS,975,RC,,,,both,1955,1368.5,,,,,,,,,,,,,,,,,,,Other,541.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,470.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,470.6,541.19, "ASST EXC BRACHIAL CLEFT CYST DEEP,ASSISTANT SURGEON",42815,HCPCS,975,RC,80,,,both,489,342.3,,,,,,,,,,,,,,,,,,,Other,86.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,75.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,75.29,86.59, PHARYNGOESOPHAGEAL REPAIR,42953,HCPCS,975,RC,,,,both,3709,2596.3,,,,,,,,,,,,,,,,,,,Other,985.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,856.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,856.68,985.17, CRICOPHARYNGEAL MYOTOMY 90G,43030,HCPCS,975,RC,,,,both,2518,1762.6,,,,,,,,,,,,,,,,,,,Other,535.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,465.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,465.64,535.48, EXCISION LESION ESOPHAGUS,43101,HCPCS,975,RC,,,,both,4213,2949.1,,,,,,,,,,,,,,,,,,,Other,1153.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1003.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1003.21,1153.69, ESOPHAGECTOMY W/O THORACOTOMY,43107,HCPCS,975,RC,,,,both,10004,7002.8,,,,,,,,,,,,,,,,,,,Other,3318.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2885.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2885.8,3318.66, PART ESOPHAG W/THORACOT & ABD INCIS,43117,HCPCS,975,RC,,,,both,10303,7212.1,,,,,,,,,,,,,,,,,,,Other,3645.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3169.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3169.97,3645.46, PARTIAL ESOPHAGECTOMY,43122,HCPCS,975,RC,,,,both,8125,5687.5,,,,,,,,,,,,,,,,,,,Other,2811.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2444.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2444.42,2811.09, DIVERTICULECTOMY ESOPHAGUS HYPOPHAR,43130,HCPCS,975,RC,,,,both,2906,2034.2,,,,,,,,,,,,,,,,,,,Other,829.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,721.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,721.28,829.47, "ASST DICERTICULECTOMY ESOPHAGUS HYPOPHAR,ASSISTANT SURGEON",43130,HCPCS,975,RC,80,,,both,727,508.9,,,,,,,,,,,,,,,,,,,Other,132.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,115.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,115.4,132.71, DIVERTICULECTOMY THORACIC,43135,HCPCS,975,RC,,,,both,5221,3654.7,,,,,,,,,,,,,,,,,,,Other,1669.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1451.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1451.81,1669.59, ESOPHAGOSCOPY DIAGNOSTIC,43200,HCPCS,975,RC,,,,both,799,559.3,,,,,,,,,,,,,,,,,,,Other,91.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,265.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,91.45,265.11, ESOPHAGOSCOPY W/BX,43202,HCPCS,975,RC,,,,both,999,699.3,,,,,,,,,,,,,,,,,,,Other,106.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,361,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,106.53,361, ESOPHAGOSCOPY W/INJECT SCLEROSIS,43204,HCPCS,975,RC,,,,both,820,574,,,,,,,,,,,,,,,,,,,Other,137.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,119.67,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,119.67,137.62, ESOPHAGOSCOPY W BAND LIG VARICES,43205,HCPCS,975,RC,,,,both,843,590.1,,,,,,,,,,,,,,,,,,,Other,143.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,124.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,124.98,143.73, EGD W/ESOPHAGASTRIC FUNDOPLASTY PARTIAL,43210,HCPCS,975,RC,,,,both,1623,1136.1,,,,,,,,,,,,,,,,,,,Other,442.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,384.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,384.42,442.09, ENDOSCOPY W/REMOVAL OF FOREIGN BODY,43215,HCPCS,975,RC,,,,both,981,686.7,,,,,,,,,,,,,,,,,,,Other,147.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,405.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,147.88,405.03, ESOPHAGOSCOPY REMOVE POLYP,43217,HCPCS,975,RC,,,,both,1148,803.6,,,,,,,,,,,,,,,,,,,Other,162.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,432.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,162.69,432.85, ESOPHAGOSCOPY FOR DILATION,43220,HCPCS,975,RC,,,,both,1091,763.7,,,,,,,,,,,,,,,,,,,Other,121.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,868.19,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,121.7,868.19, DILATION ESOPHAGUS OVER GUIDE WIRE,43226,HCPCS,975,RC,,,,both,990,693,,,,,,,,,,,,,,,,,,,Other,136.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,385.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.58,385.34, UGI W/ BALLOON DILATION /FLOURO,43233,HCPCS,975,RC,,,,both,978,684.6,,,,,,,,,,,,,,,,,,,Other,238.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,207.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,207.09,238.16, UGI ENDOSCOPY DIAGNOSTIC,43235,HCPCS,975,RC,,,,both,893,625.1,,,,,,,,,,,,,,,,,,,Other,126.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,299.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,126.31,299.61, UGI W INJECTION,43236,HCPCS,975,RC,,,,both,1091,763.7,,,,,,,,,,,,,,,,,,,Other,141.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,411.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,141.39,411.65, EGD W/ENDOSCOPIC ULTRASOUND EXAM LIMTED,43237,HCPCS,975,RC,,,,both,938,656.6,,,,,,,,,,,,,,,,,,,Other,198.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,172.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,172.52,198.4, UGI ENDOSCOPY BIOPSY,43239,HCPCS,975,RC,,,,both,1016,711.2,,,,,,,,,,,,,,,,,,,Other,141.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,387.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,141.39,387.14, UGI DX WITH DABHOFF TUBE,43241,HCPCS,975,RC,,,,both,875,612.5,,,,,,,,,,,,,,,,,,,Other,145.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,126.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,126.87,145.9, UGI WITH SCLERO FOR ULCER/VARICOSIT,43243,HCPCS,975,RC,,,,both,993,695.1,,,,,,,,,,,,,,,,,,,Other,241.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,210.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,210.2,241.73, UGI W/BAND LIGAT ESOPH/GAST VARICES,43244,HCPCS,975,RC,,,,both,1060,742,,,,,,,,,,,,,,,,,,,Other,247.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,214.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,214.97,247.21, UGI DILATION GASTRIC OUTLET,43245,HCPCS,975,RC,,,,both,1144,800.8,,,,,,,,,,,,,,,,,,,Other,181.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,603.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,181.62,603.52, PEG UGI ENDOSCOPY PEG TUBE 00G,43246,HCPCS,975,RC,,,,both,1070,749,,,,,,,,,,,,,,,,,,,Other,207.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,180.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,180.74,207.85, UGI WITH FOREIGN BODY REMOVAL,43247,HCPCS,975,RC,,,,both,1046,732.2,,,,,,,,,,,,,,,,,,,Other,181.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,398.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,181.09,398.05, UGI W DIL OF ESOPH OVER GUIDE WIRE,43248,HCPCS,975,RC,,,,both,976,683.2,,,,,,,,,,,,,,,,,,,Other,169.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,425.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,169.87,425.05, UGI ENDOSCOPY WITH BALLOON DILATION,43249,HCPCS,975,RC,,,,both,1022,715.4,,,,,,,,,,,,,,,,,,,Other,156.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1001.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,156.07,1001.56, UGI EXC POLYP HOT BX /BIPOLAR CAUT,43250,HCPCS,975,RC,,,,both,1067,746.9,,,,,,,,,,,,,,,,,,,Other,176.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,463.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,176.84,463.38, UGI W/REMOV OF TUMORS POLYPS,43251,HCPCS,975,RC,,,,both,1143,800.1,,,,,,,,,,,,,,,,,,,Other,198.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,506.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,198.64,506.25, UGI CONTROL BLEEDING,43255,HCPCS,975,RC,,,,both,1215,850.5,,,,,,,,,,,,,,,,,,,Other,203.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,634.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,203.06,634.71, ERCP,43260,HCPCS,975,RC,,,,both,1341,938.7,,,,,,,,,,,,,,,,,,,Other,322.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,280.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,280.76,322.87, ERCP WITH BIOPSY,43261,HCPCS,975,RC,,,,both,1416,991.2,,,,,,,,,,,,,,,,,,,Other,340.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,295.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,295.82,340.2, ERCP W/SPHINCTEROTOMY/PAPILLO,43262,HCPCS,975,RC,,,,both,1602,1121.4,,,,,,,,,,,,,,,,,,,Other,358.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,311.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,311.47,358.19, ERCP W/ENDSCPC REMOVL OF STONE,43264,HCPCS,975,RC,,,,both,1851,1295.7,,,,,,,,,,,,,,,,,,,Other,365.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,317.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,317.63,365.28, UGI W/ESOPH STENT W/DILAT PRE&POST,43266,HCPCS,975,RC,,,,both,977,683.9,,,,,,,,,,,,,,,,,,,Other,222.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,193.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,193.23,222.22, LAP NISSEN 90G,43280,HCPCS,975,RC,,,,both,4170,2919,,,,,,,,,,,,,,,,,,,Other,1211.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1053.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1053.66,1211.7, LAP PARAESOPH HERN W/FUNDO W/O MESH 90G,43281,HCPCS,975,RC,,,,both,5720,4004,,,,,,,,,,,,,,,,,,,Other,1716.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1492.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1492.38,1716.24, LAP DIAPH REPAIR W/FUND W/MESH 90,43282,HCPCS,975,RC,,,,both,6061,4242.7,,,,,,,,,,,,,,,,,,,Other,1932.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1680.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1680.7,1932.8, LAPAROSCOPY SURGICAL ESOPHAGEAL LENGTHEN,43283,HCPCS,975,RC,,,,both,639,447.3,,,,,,,,,,,,,,,,,,,Other,173.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,150.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,150.74,173.35, LINX,43284,HCPCS,975,RC,,,,both,2433,1703.1,,,,,,,,,,,,,,,,,,,Other,741.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,644.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,644.74,741.46, REMOVAL OF ESOPHAGEAL SPHINCTER AUGMENTA,43285,HCPCS,975,RC,,,,both,2421,1694.7,,,,,,,,,,,,,,,,,,,Other,762.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,663.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,663.05,762.51, "ASST LAP NISSEN,ASSISTANT SURGEON",43280,HCPCS,975,RC,80,,,both,1043,730.1,,,,,,,,,,,,,,,,,,,Other,193.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,168.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,168.59,193.87, "ASST LAP PARAESOPH HERN W/FUNDO W/O MESH,ASSISTANT SURGEON",43281,HCPCS,975,RC,80,,,both,1430,1001,,,,,,,,,,,,,,,,,,,Other,274.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,238.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,238.78,274.6, "ASST DIAPH HERNIA REPAIR W/MESH,ASSISTANT SURGEON",43282,HCPCS,975,RC,80,,,both,1515,1060.5,,,,,,,,,,,,,,,,,,,Other,309.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,268.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,268.91,309.25, "ASST LAPAROSCOPY SURGICAL ESOPHAGEAL LEN,ASSISTANT SURGEON",43283,HCPCS,975,RC,80,,,both,160,112,,,,,,,,,,,,,,,,,,,Other,27.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.12,27.73, "ASST REMOVAL ESOPHAGEAL SPHINCTER AUGMEN,ASSISTANT SURGEON",43285,HCPCS,975,RC,80,,,both,605,423.5,,,,,,,,,,,,,,,,,,,Other,122,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,106.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,106.08,122, NISSEN OPEN ABDOMINAL,43327,HCPCS,975,RC,,,,both,3600,2520,,,,,,,,,,,,,,,,,,,Other,941.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,818.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,818.89,941.72, "ASST NISSEN OPEN ABDOMINAL,ASSISTANT SURGEON",43327,HCPCS,975,RC,80,,,both,2967,2076.9,,,,,,,,,,,,,,,,,,,Other,150.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,131.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,131.03,150.68, PARAESOPH HERNIA W/WO FUNDOPLIC 90,43332,HCPCS,975,RC,,,,both,4185,2929.5,,,,,,,,,,,,,,,,,,,Other,1291.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1122.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1122.7,1291.1, "ASST LAPAROTOMY DIAPH HERNIA REPAIR,ASSISTANT SURGEON",43332,HCPCS,975,RC,80,,,both,1046,732.2,,,,,,,,,,,,,,,,,,,Other,206.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,179.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,179.63,206.57, PARAESOPH HERNIA OPEN REPAIR/MESH90,43333,HCPCS,975,RC,,,,both,4669,3268.3,,,,,,,,,,,,,,,,,,,Other,1410.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1226.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1226.64,1410.63, "ASST DIAPH HERNIA/MESH OPEN,ASSISTANT SURGEON",43333,HCPCS,975,RC,80,,,both,1167,816.9,,,,,,,,,,,,,,,,,,,Other,225.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,196.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,196.26,225.7, ESOPHAGEAL LENGTHENING PROCEDURE (COLLIS,43338,HCPCS,975,RC,,,,both,483,338.1,,,,,,,,,,,,,,,,,,,Other,126.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,110.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,110.04,126.55, "ESOPHAGEAL LENGTHENING PROCEDURE (COLLIS,ASSISTANT SURGEON",43338,HCPCS,975,RC,80,,,both,121,84.7,,,,,,,,,,,,,,,,,,,Other,20.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.61,20.25, LIGATION DIRECT ESOPHAGEAL VARICES,43400,HCPCS,975,RC,,,,both,4886,3420.2,,,,,,,,,,,,,,,,,,,Other,1706.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1483.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1483.71,1706.27, "ASST LIGATION DIRECT ESOPHAGEAL VARICES,ASSISTANT SURGEON",43400,HCPCS,975,RC,80,,,both,1221,854.7,,,,,,,,,,,,,,,,,,,Other,273,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,237.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,237.4,273, DILATION ESOPHAGUS INITIAL SESSION,43450,HCPCS,975,RC,,,,both,462,323.4,,,,,,,,,,,,,,,,,,,Other,83.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,196.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,83.03,196.52, ESOPHAGEAL DILATION GUIDE WIRE 0G,43453,HCPCS,975,RC,,,,both,828,579.6,,,,,,,,,,,,,,,,,,,Other,88.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,751.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,88.63,751.87, GASTROTOMY OVERSEW BLEEDING ULCER,43501,HCPCS,975,RC,,,,both,4132,2892.4,,,,,,,,,,,,,,,,,,,Other,1520.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1321.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1321.84,1520.12, GASTROTOMY REPAIR ESOPHAGOGASTRIC,43502,HCPCS,975,RC,,,,both,5144,3600.8,,,,,,,,,,,,,,,,,,,Other,1710.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1487.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1487.08,1710.14, PYLORMYOTOMY,43520,HCPCS,975,RC,,,,both,2645,1851.5,,,,,,,,,,,,,,,,,,,Other,808.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,703.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,703.27,808.75, STOMACH BIOPSY 90,43605,HCPCS,975,RC,,,,both,2690,1883,,,,,,,,,,,,,,,,,,,Other,955.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,830.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,830.62,955.22, EXCISION STOMACH PARTIAL LOCAL,43610,HCPCS,975,RC,,,,both,3557,2489.9,,,,,,,,,,,,,,,,,,,Other,1098.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,955,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,955,1098.25, BX GASTRIC WALL,43611,HCPCS,975,RC,,,,both,4373,3061.1,,,,,,,,,,,,,,,,,,,Other,1368.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1190.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1190.16,1368.69, GASTRECTOMY TOTAL; W/ESOPHAGOENTER,43620,HCPCS,975,RC,,,,both,7192,5034.4,,,,,,,,,,,,,,,,,,,Other,2213.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1924.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1924.96,2213.7, EXCIS GASTRECTOMY W/ROUX-EN Y RECON 90G,43621,HCPCS,975,RC,,,,both,8523,5966.1,,,,,,,,,,,,,,,,,,,Other,2517.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2189.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2189.24,2517.63, "ASST GASTRECTOMY TOTAL; W/ESOPHAGOENTER,ASSISTANT SURGEON",43620,HCPCS,975,RC,80,,,both,1798,1258.6,,,,,,,,,,,,,,,,,,,Other,354.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,307.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,307.99,354.19, "ASST EXCIS GASTRECTOMY W/ROUX-EN Y RECON,ASSISTANT SURGEON",43621,HCPCS,975,RC,80,,,both,2131,1491.7,,,,,,,,,,,,,,,,,,,Other,402.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,350.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,350.28,402.82, PARTIAL GASTRECTOMY W GASTRODUODENO,43631,HCPCS,975,RC,,,,both,4744,3320.8,,,,,,,,,,,,,,,,,,,Other,1623.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1411.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1411.74,1623.5, GASTRECTOMY PART DIST;W/GASTROJEJU,43632,HCPCS,975,RC,,,,both,6553,4587.1,,,,,,,,,,,,,,,,,,,Other,2255.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1961.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1961.15,2255.32, BPD PARTIAL GASTRECTOMY ROUX/Y 90G,43633,HCPCS,975,RC,,,,both,6497,4547.9,,,,,,,,,,,,,,,,,,,Other,2134.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1855.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1855.68,2134.03, "ASST PARTIAL GASTRECTOMY W/GASTRODUODENO,ASSISTANT SURGEON",43631,HCPCS,975,RC,80,,,both,1186,830.2,,,,,,,,,,,,,,,,,,,Other,259.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,225.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,225.88,259.76, HEMIGASTRECTOMY WITH VAGOTOMY,43635,HCPCS,975,RC,,,,both,476,333.2,,,,,,,,,,,,,,,,,,,Other,123.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,107.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,107.25,123.34, "ASST GASTRECTOMY PART DIST W/GASTROJEJU,ASSISTANT SURGEON",43632,HCPCS,975,RC,80,,,both,1638,1146.6,,,,,,,,,,,,,,,,,,,Other,360.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,313.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,313.79,360.86, "ASST GASTRECTOMY PARTIAL W/ ROUX/Y,ASSISTANT SURGEON",43633,HCPCS,975,RC,80,,,both,1634,1143.8,,,,,,,,,,,,,,,,,,,Other,341.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,296.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,296.91,341.44, "ASST HEMIGASTRECTOMY W/ VAGOTOMY,ASSISTANT SURGEON",43635,HCPCS,975,RC,80,,,both,119,83.3,,,,,,,,,,,,,,,,,,,Other,19.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.16,19.74, VAGOTOMY W PYLOROPLASTY W/WO GASTR,43640,HCPCS,975,RC,,,,both,3676,2573.2,,,,,,,,,,,,,,,,,,,Other,1341.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1166.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1166.14,1341.06, VAGOTOMY; PARIETAL CELL(HIGHLY SEL),43641,HCPCS,975,RC,,,,both,3869,2708.3,,,,,,,,,,,,,,,,,,,Other,1355.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1178.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1178.86,1355.69, LAP VAGOTOMY HIGHLY SELECTIVE,43652,HCPCS,975,RC,,,,both,2811,1967.7,,,,,,,,,,,,,,,,,,,Other,869.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,756.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,756.31,869.75, "ASST LAP VAGOTOMY HIGHLY SELECTIVE,ASSISTANT SURGEON",43652,HCPCS,975,RC,80,,,both,703,492.1,,,,,,,,,,,,,,,,,,,Other,139.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,121.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,121.01,139.16, LAP GASTROSTOMY STAMM,43653,HCPCS,975,RC,,,,both,2290,1603,,,,,,,,,,,,,,,,,,,Other,661.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,575.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,575.16,661.44, NG OR ORO-GASTRIC TUBE PLACE,43752,HCPCS,975,RC,,,,both,213,149.1,,,,,,,,,,,,,,,,,,,Other,40.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.95,40.19, GASTRIC INTUBATION/ASPIRATION INCLUDING,43753,HCPCS,960,RC,,,,both,184,128.8,,,,,,,,,,,,,,,,,,,Other,24.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,21.19,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,21.19,24.36, GASTRIC INTUBATION ASP DX SPECIMEN,43754,HCPCS,960,RC,,,,both,276,193.2,,,,,,,,,,,,,,,,,,,Other,53.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,270.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,53.27,270.48, REPOSITIONING GASTROSTOMY TUBE,43761,HCPCS,975,RC,,,,both,446,312.2,,,,,,,,,,,,,,,,,,,Other,104.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,121.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,104.35,121.52, REPLACEMENT OF GASTROSTOMY TUBE INCLUDES,43762,HCPCS,975,RC,,,,both,514,359.8,,,,,,,,,,,,,,,,,,,Other,41.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,248.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,41.46,248.83, REPLCMENT OF G-TUBE W/ REVISION OF GASTR,43763,HCPCS,975,RC,,,,both,645,451.5,,,,,,,,,,,,,,,,,,,Other,96.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,343.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,96.91,343.08, LAP SLEEVE GASTRECTOMY,43775,HCPCS,975,RC,,,,both,5867,4106.9,,,,,,,,,,,,,,,,,,,Other,1222.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1063.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1063.26,1222.75, "ASST LAP SLEEVE GASTRECTOMY,ASSISTANT SURGEON",43775,HCPCS,975,RC,80,,,both,1467,1026.9,,,,,,,,,,,,,,,,,,,Other,195.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,170.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,170.12,195.64, PYLOROPLASTY,43800,HCPCS,975,RC,,,,both,3079,2155.3,,,,,,,,,,,,,,,,,,,Other,1037.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,901.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,901.81,1037.08, GASTRODUODENOSTOMY,43810,HCPCS,975,RC,,,,both,3487,2440.9,,,,,,,,,,,,,,,,,,,Other,1145.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,995.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,995.8,1145.17, GASTROJEJUNOSTOMY 90G,43820,HCPCS,975,RC,,,,both,4657,3259.9,,,,,,,,,,,,,,,,,,,Other,1500.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1304.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1304.71,1500.42, "ASST GASTROJEJUNOSTOMY,ASSISTANT SURGEON",43820,HCPCS,975,RC,80,,,both,1164,814.8,,,,,,,,,,,,,,,,,,,Other,240.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,208.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,208.75,240.07, GASTROSTOMY TUBE PLCEMNT STAMM 90G,43830,HCPCS,975,RC,,,,both,2376,1663.2,,,,,,,,,,,,,,,,,,,Other,795.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,692.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,692.03,795.83, "ASST STAMM TEMPORARY GASTROSTOMY,ASSISTANT SURGEON",43830,HCPCS,975,RC,80,,,both,594,415.8,,,,,,,,,,,,,,,,,,,Other,127.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,110.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,110.72,127.33, GASTROSTOMY TUBE PERMANENT,43832,HCPCS,975,RC,,,,both,3381,2366.7,,,,,,,,,,,,,,,,,,,Other,1177.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1023.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1023.55,1177.09, "ASST GASTROSTOMY TUBE PERMANENT,ASSISTANT SURGEON",43832,HCPCS,975,RC,80,,,both,845,591.5,,,,,,,,,,,,,,,,,,,Other,188.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,163.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,163.77,188.34, GASTORRHAPHY SUTR PERF DUOD GAS ULC,43840,HCPCS,975,RC,,,,both,4517,3161.9,,,,,,,,,,,,,,,,,,,Other,1522.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1323.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1323.93,1522.52, "ASST GASTORRAPHY,ASSISTANT SURGEON",43840,HCPCS,975,RC,80,,,both,1129,790.3,,,,,,,,,,,,,,,,,,,Other,243.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,211.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,211.83,243.6, GASTRIC BANDING,43842,HCPCS,960,RC,,,,both,3953,2767.1,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, SLEVE /OTHER GASTRIC RESTRICTIVE PR,43843,HCPCS,975,RC,,,,both,4497,3147.9,,,,,,,,,,,,,,,,,,,Other,1444.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1256,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1256,1444.39, BPD/DUOD SWITCH W/PART GASTREC,43845,HCPCS,975,RC,,,,both,8710,6097,,,,,,,,,,,,,,,,,,,Other,2195.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1909.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1909.52,2195.94, "ASST BPD PARTIAL GASTR DUOD SWITCH,ASSISTANT SURGEON",43845,HCPCS,975,RC,80,,,both,2178,1524.6,,,,,,,,,,,,,,,,,,,Other,351.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,305.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,305.52,351.35, GASTRIC BYPASS W/SHORT ROUX-EN-Y,43846,HCPCS,975,RC,,,,both,6717,4701.9,,,,,,,,,,,,,,,,,,,Other,1854.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1613.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1613.01,1854.96, GASTRIC BYPASS W/ SMALL BOWEL RE,43847,HCPCS,975,RC,,,,both,7225,5057.5,,,,,,,,,,,,,,,,,,,Other,2026.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1762.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1762.54,2026.92, REVISION ROUX-EN-Y,43848,HCPCS,975,RC,,,,both,7465,5225.5,,,,,,,,,,,,,,,,,,,Other,2151.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1871.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1871.28,2151.97, REVISION GASTROJEJUNAL ANASTOMOSIS,43860,HCPCS,975,RC,,,,both,5854,4097.8,,,,,,,,,,,,,,,,,,,Other,1818.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1580.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1580.94,1818.08, "ASST REVISION GASTROJEJUNAL ANASTOMOSIS,ASSISTANT SURGEON",43860,HCPCS,975,RC,80,,,both,1464,1024.8,,,,,,,,,,,,,,,,,,,Other,290.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,252.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,252.95,290.89, CLOSURE OF GASTROSTOMY SURGICAL,43870,HCPCS,975,RC,,,,both,2549,1784.3,,,,,,,,,,,,,,,,,,,Other,796.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,692.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,692.41,796.27, ENTEROLYSIS 90G,44005,HCPCS,975,RC,,,,both,3652,2556.4,,,,,,,,,,,,,,,,,,,Other,1219.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1060.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1060.84,1219.96, "ASST LAPAROTOMY W LOA,ASSISTANT SURGEON",44005,HCPCS,975,RC,80,,,both,913,639.1,,,,,,,,,,,,,,,,,,,Other,195.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,169.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,169.74,195.2, INCIS DUODENOTOMY FOR EXPLOR BIOPSY,44010,HCPCS,975,RC,,,,both,2811,1967.7,,,,,,,,,,,,,,,,,,,Other,915.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,795.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,795.97,915.36, FEEDING JEJUNOSTOMY NO MODS,44015,HCPCS,975,RC,,,,both,762,533.4,,,,,,,,,,,,,,,,,,,Other,153.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,133.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,133.72,153.78, "ASST FEEDING JEJUNOSTOMY,ASSISTANT SURGEON",44015,HCPCS,975,RC,80,,,both,191,133.7,,,,,,,,,,,,,,,,,,,Other,24.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,21.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,21.39,24.61, ENTEROTOMY SMALL INTEST DECOMPRESS,44021,HCPCS,975,RC,,,,both,3281,2296.7,,,,,,,,,,,,,,,,,,,Other,1084.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,942.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,942.71,1084.12, COLOTOMY FOR EXPL BX OR FB REMOVAL,44025,HCPCS,975,RC,,,,both,3314,2319.8,,,,,,,,,,,,,,,,,,,Other,1095.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,952.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,952.21,1095.04, REDUCT INT HERNIA VOLVULUS,44050,HCPCS,975,RC,,,,both,3175,2222.5,,,,,,,,,,,,,,,,,,,Other,1051.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,914.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,914.1,1051.21, "ASST REDUCT INT HERNIA VOLVULUS,ASSISTANT SURGEON",44050,HCPCS,975,RC,80,,,both,794,555.8,,,,,,,,,,,,,,,,,,,Other,168.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,146.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,146.26,168.2, LG OR SML BOWEL EXCISION LESION,44110,HCPCS,975,RC,,,,both,3263,2284.1,,,,,,,,,,,,,,,,,,,Other,943,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,820.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,820.01,943, EXCISIONS BOWEL MULTI-ENTEROTOMIES,44111,HCPCS,975,RC,,,,both,3639,2547.3,,,,,,,,,,,,,,,,,,,Other,1068.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,929.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,929.04,1068.4, ENTERECTOMY WITH ANASTOMOSIS 90G,44120,HCPCS,975,RC,,,,both,4378,3064.6,,,,,,,,,,,,,,,,,,,Other,1360.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1183.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1183.01,1360.46, RESECTION ADDTL W/ANAST,44121,HCPCS,975,RC,,,,both,1039,727.3,,,,,,,,,,,,,,,,,,,Other,263.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,228.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,228.75,263.06, "ASST ENTERECTOMY WITH ANASTOMOSIS,ASSISTANT SURGEON",44120,HCPCS,975,RC,80,,,both,1095,766.5,,,,,,,,,,,,,,,,,,,Other,217.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,189.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,189.28,217.68, "ASST PARTIAL ENTERECT ADDITIONAL,ASSISTANT SURGEON",44121,HCPCS,975,RC,80,,,both,260,182,,,,,,,,,,,,,,,,,,,Other,42.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.6,42.09, ENTEROENTEROSTOMY 90 G,44130,HCPCS,975,RC,,,,both,4580,3206,,,,,,,,,,,,,,,,,,,Other,1467.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1276.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1276.28,1467.73, "ASST ENTEROENTEROSTOMY,ASSISTANT SURGEON",44130,HCPCS,975,RC,80,,,both,1145,801.5,,,,,,,,,,,,,,,,,,,Other,234.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,204.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,204.2,234.84, MOBILIZATION WITH COLECTOMY SEP,44139,HCPCS,975,RC,,,,both,513,359.1,,,,,,,,,,,,,,,,,,,Other,129.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,112.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,112.24,129.08, "ASST TAKEDOWN SPLENIC FLEXURE SEP,ASSISTANT SURGEON",44139,HCPCS,975,RC,80,,,both,128,89.6,,,,,,,,,,,,,,,,,,,Other,20.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.95,20.65, PARTIAL COLECTOMY ANASTOMOSIS 90,44140,HCPCS,975,RC,,,,both,4524,3166.8,,,,,,,,,,,,,,,,,,,Other,1490.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1296.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1296.23,1490.66, PARTIAL COLECTOMY W SKIN LEVEL CECO,44141,HCPCS,975,RC,,,,both,5879,4115.3,,,,,,,,,,,,,,,,,,,Other,2010.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1748.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1748.47,2010.73, "ASST PARTIAL COLECTOMY W/ANASTOMOSI,ASSISTANT SURGEON",44140,HCPCS,975,RC,80,,,both,1131,791.7,,,,,,,,,,,,,,,,,,,Other,238.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,207.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,207.4,238.5, HEMICOLECT W ANAST END COLOST HARTMANN P,44143,HCPCS,975,RC,,,,both,5486,3840.2,,,,,,,,,,,,,,,,,,,Other,1825.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1587.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1587.24,1825.32, PART COLECTOMY W/RESEC & COLOST OR,44144,HCPCS,975,RC,,,,both,5614,3929.8,,,,,,,,,,,,,,,,,,,Other,1949.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1694.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1694.98,1949.23, COLECTOMY WITH COLOPROCTOSTOMY 90G,44145,HCPCS,975,RC,,,,both,5937,4155.9,,,,,,,,,,,,,,,,,,,Other,1801.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1566.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1566.53,1801.51, LOW ANT COLON RESECTION WITH ANAST,44146,HCPCS,975,RC,,,,both,7163,5014.1,,,,,,,,,,,,,,,,,,,Other,2304.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2003.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2003.62,2304.17, LOW ANT COLON RESECT ABD/TRANSANAL,44147,HCPCS,975,RC,,,,both,5979,4185.3,,,,,,,,,,,,,,,,,,,Other,2097.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1823.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1823.68,2097.24, "ASST PARTIAL COLECTOMY HARTMANS,ASSISTANT SURGEON",44143,HCPCS,975,RC,80,,,both,1372,960.4,,,,,,,,,,,,,,,,,,,Other,292.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,253.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,253.96,292.05, "ASST HEMICOLECTOMY WITH ANASTOMOSIS,ASSISTANT SURGEON",44145,HCPCS,975,RC,80,,,both,1484,1038.8,,,,,,,,,,,,,,,,,,,Other,288.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,250.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,250.64,288.24, TOTAL COLECTOMY 90G,44150,HCPCS,975,RC,,,,both,6357,4449.9,,,,,,,,,,,,,,,,,,,Other,2043.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1776.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1776.62,2043.11, "ASST TOTAL COLECTOMY,ASSISTANT SURGEON",44150,HCPCS,975,RC,80,,,both,1589,1112.3,,,,,,,,,,,,,,,,,,,Other,326.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,284.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,284.26,326.9, "ASST LOW ANT RESECT ABDOM/ANAL,ASSISTANT SURGEON",44147,HCPCS,975,RC,80,,,both,1495,1046.5,,,,,,,,,,,,,,,,,,,Other,335.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,291.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,291.79,335.56, TOTAL COLECTOMY WITH ILEOSTOMY,44155,HCPCS,975,RC,,,,both,7012,4908.4,,,,,,,,,,,,,,,,,,,Other,2268.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1972.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1972.6,2268.49, COLECTOMY TOTAL MUCO ANAST LOOP,44157,HCPCS,975,RC,,,,both,6690,4683,,,,,,,,,,,,,,,,,,,Other,2443.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2124.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2124.6,2443.29, COLECTOMY PARTIAL W/ILEOCOLOSTOMY 90G,44160,HCPCS,975,RC,,,,both,4404,3082.8,,,,,,,,,,,,,,,,,,,Other,1377.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1197.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1197.79,1377.45, "ASST COLECTOMY PARTIAL W/ILEOCOLOSTOMY 9,ASSISTANT SURGEON",44160,HCPCS,975,RC,80,,,both,1101,770.7,,,,,,,,,,,,,,,,,,,Other,220.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,191.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,191.65,220.39, LAPARASCOPIC LOA 90G,44180,HCPCS,975,RC,,,,both,3105,2173.5,,,,,,,,,,,,,,,,,,,Other,1030.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,896.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,896.46,1030.93, "ASST LAP ENTEROLYSIS,ASSISTANT SURGEON",44180,HCPCS,975,RC,80,,,both,776,543.2,,,,,,,,,,,,,,,,,,,Other,164.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,143.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,143.43,164.95, LAP ILEOSTOMY OR JEJUNOSTOMY NON-TUBE,44187,HCPCS,975,RC,,,,both,3172,2220.4,,,,,,,,,,,,,,,,,,,Other,1193.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1037.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1037.55,1193.18, "LAP ILEOSTOMY OR JEJUNOSTOMY NON-TUBE; A,ASSISTANT SURGEON",44187,HCPCS,975,RC,80,,,both,793,555.1,,,,,,,,,,,,,,,,,,,Other,190.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,166.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,166.01,190.9, LAP COLOSTOMY OR SKIN LEVEL CECOSTOMY,44188,HCPCS,975,RC,,,,both,4389,3072.3,,,,,,,,,,,,,,,,,,,Other,1337.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1163,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1163,1337.45, "LAP COLOSTOMY OR SKIN LEVEL CECOSTOMY AS,ASSISTANT SURGEON",44188,HCPCS,975,RC,80,,,both,1097,767.9,,,,,,,,,,,,,,,,,,,Other,213.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,186.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,186.08,213.99, LAP PARTIAL COLECTOMY WITH ANAST 90G,44204,HCPCS,975,RC,,,,both,5286,3700.2,,,,,,,,,,,,,,,,,,,Other,1679.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1460.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1460.14,1679.16, "ASST LAP PARTIAL COLECTOMY WITH ANAST,ASSISTANT SURGEON",44204,HCPCS,975,RC,80,,,both,1322,925.4,,,,,,,,,,,,,,,,,,,Other,268.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,233.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,233.62,268.67, LAP COLECTOMY PART/REM/TERM ILEUM 90G,44205,HCPCS,975,RC,,,,both,4733,3313.1,,,,,,,,,,,,,,,,,,,Other,1451.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1262.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1262.51,1451.89, "ASST LAP HEMICOLECTOMY W/ANAST,ASSISTANT SURGEON",44205,HCPCS,975,RC,80,,,both,1183,828.1,,,,,,,,,,,,,,,,,,,Other,232.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,202,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,202,232.3, LAP SIGMOID COLECTOMY 90G,44207,HCPCS,975,RC,,,,both,6536,4575.2,,,,,,,,,,,,,,,,,,,Other,1954.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1699.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1699.66,1954.61, "ASST LAP SIGMOID COLECTOMY,ASSISTANT SURGEON",44207,HCPCS,975,RC,80,,,both,1634,1143.8,,,,,,,,,,,,,,,,,,,Other,312.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,271.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,271.95,312.74, LAP COLECTOMY TOTAL W/O PROCTECTOMY W/IL,44210,HCPCS,975,RC,,,,both,6127,4288.9,,,,,,,,,,,,,,,,,,,Other,1906.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1657.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1657.51,1906.14, "ASST LAP COLECTOMY TOTAL W/O PROCTECTOMY,ASSISTANT SURGEON",44210,HCPCS,975,RC,80,,,both,1532,1072.4,,,,,,,,,,,,,,,,,,,Other,304.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,265.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,265.2,304.99, LAP TAKEDOWN OF SPLENIC FLEXURE + (ADD-O,44213,HCPCS,975,RC,,,,both,697,487.9,,,,,,,,,,,,,,,,,,,Other,198.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,172.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,172.24,198.07, "ASST LAP TAKEDOWN SPLENIC FLEXURE,ASSISTANT SURGEON",44213,HCPCS,975,RC,80,,,both,174,121.8,,,,,,,,,,,,,,,,,,,Other,31.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.56,31.69, ENTEROSTOMY CECOSTOMY TUBE 90G,44300,HCPCS,975,RC,,,,both,2740,1918,,,,,,,,,,,,,,,,,,,Other,946.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,822.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,822.78,946.2, "ASST ENTEROSTOMY CECOSTOMY TUBE,ASSISTANT SURGEON",44300,HCPCS,975,RC,80,,,both,685,479.5,,,,,,,,,,,,,,,,,,,Other,151.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,131.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,131.64,151.39, ILEOSTOMY/JEJUNOSTOMY,44310,HCPCS,975,RC,,,,both,3784,2648.8,,,,,,,,,,,,,,,,,,,Other,1146,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,996.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,996.52,1146, "ASST ILEO--JEJUNOSTOMY,ASSISTANT SURGEON",44310,HCPCS,975,RC,80,,,both,946,662.2,,,,,,,,,,,,,,,,,,,Other,183.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,159.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,159.45,183.36, ILEOSTOMY REVISION,44312,HCPCS,975,RC,,,,both,2119,1483.3,,,,,,,,,,,,,,,,,,,Other,663.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,576.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,576.86,663.38, ILEOSTOMY REVISION COMPLICATED,44314,HCPCS,975,RC,,,,both,3416,2391.2,,,,,,,,,,,,,,,,,,,Other,1098.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,955.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,955.05,1098.31, COLOSTOMY OR SKIN LEVEL CECOSTOMY 90G,44320,HCPCS,975,RC,,,,both,4121,2884.7,,,,,,,,,,,,,,,,,,,Other,1328.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1154.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1154.86,1328.09, "ASST COLOSTOMY,ASSISTANT SURGEON",44320,HCPCS,975,RC,80,,,both,1030,721,,,,,,,,,,,,,,,,,,,Other,212.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,184.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,184.78,212.49, REVISION OF COLOSTOMY SIMPLE,44340,HCPCS,975,RC,,,,both,2076,1453.2,,,,,,,,,,,,,,,,,,,Other,703.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,611.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,611.85,703.63, REVISE COLOSTOMY COMPLICATED,44345,HCPCS,975,RC,,,,both,3664,2564.8,,,,,,,,,,,,,,,,,,,Other,1161.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1010.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1010.41,1161.97, REV COLOSTOMY REPAIR PARACOL HERNIA,44346,HCPCS,975,RC,,,,both,3947,2762.9,,,,,,,,,,,,,,,,,,,Other,1298.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1128.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1128.71,1298.01, SMALL INTESTINE ENDOSC/BRUSH/WASH,44360,HCPCS,975,RC,,,,both,786,550.2,,,,,,,,,,,,,,,,,,,Other,145.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,126.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,126.62,145.61, DUOD ENDO W/CONTROL BLEEDING,44366,HCPCS,975,RC,,,,both,1179,825.3,,,,,,,,,,,,,,,,,,,Other,241.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,209.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,209.78,241.25, NG TUBE WITH ENTEROSCOPY,44372,HCPCS,975,RC,,,,both,1111,777.7,,,,,,,,,,,,,,,,,,,Other,245.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,213.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,213.4,245.41, ILEOSCOPY THRU STOMA,44380,HCPCS,975,RC,,,,both,521,364.7,,,,,,,,,,,,,,,,,,,Other,59.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,204.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,59.63,204.57, ILEOSCOPY THROUGH STOMA W BIOPSY,44382,HCPCS,975,RC,,,,both,661,462.7,,,,,,,,,,,,,,,,,,,Other,76.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,305.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,76.68,305.47, EDOSCOPY SMALL BOWEL STOMA W BX,44386,HCPCS,975,RC,,,,both,1350,945,,,,,,,,,,,,,,,,,,,Other,92.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,319.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,92.7,319.09, COLONOSCOPY THROUGH COLOSTOMY,44388,HCPCS,975,RC,,,,both,1089,762.3,,,,,,,,,,,,,,,,,,,Other,163.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,332.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,163.74,332.75, COLONOSCOPY THRU STOMA WITH BIOPSY,44389,HCPCS,975,RC,,,,both,1291,903.7,,,,,,,,,,,,,,,,,,,Other,177.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,426.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,177.51,426.31, COLONOSCOPY/STOMA W CONTROL BLEED,44391,HCPCS,975,RC,,,,both,1364,954.8,,,,,,,,,,,,,,,,,,,Other,233.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,649.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,233.63,649.34, COLONOSCOPY THRU STOMA W/REM LES,44394,HCPCS,975,RC,,,,both,1359,951.3,,,,,,,,,,,,,,,,,,,Other,230.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,454.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,230.87,454.78, COLONOSCOPY THRU STOMA W/INJ,44404,HCPCS,975,RC,,,,both,1123,786.1,,,,,,,,,,,,,,,,,,,Other,176.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,433.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,176.58,433.27, REPAIR SMALL INTESTINE 90G,44602,HCPCS,975,RC,,,,both,4654,3257.8,,,,,,,,,,,,,,,,,,,Other,1553.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1350.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1350.75,1553.37, "ASST REPAIR SMALL INTESTINE,ASSISTANT SURGEON",44602,HCPCS,975,RC,80,,,both,1164,814.8,,,,,,,,,,,,,,,,,,,Other,248.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,216.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,216.12,248.54, REPAIR SMALL BOWEL MULTIPLE PERF,44603,HCPCS,975,RC,,,,both,5160,3612,,,,,,,,,,,,,,,,,,,Other,1780.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1548,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1548,1780.2, SUTURE LARGE INTESTINE PERFORATION,44604,HCPCS,975,RC,,,,both,3640,2548,,,,,,,,,,,,,,,,,,,Other,1165.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1013.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1013.33,1165.33, STRICTUROPLASTY,44615,HCPCS,975,RC,,,,both,3626,2538.2,,,,,,,,,,,,,,,,,,,Other,1183.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1028.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1028.79,1183.11, "ASST STRICTUROPLASTY,ASSISTANT SURGEON",44615,HCPCS,975,RC,80,,,both,906.5,634.55,,,,,,,,,,,,,,,,,,,Other,189.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,164.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,164.61,189.3, CLOSE ENTEROSTOMY LG OR SMALL INTES,44620,HCPCS,975,RC,,,,both,2986,2090.2,,,,,,,,,,,,,,,,,,,Other,947.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,824.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,824.08,947.7, CLOSURE ENTEROSTOMY W ANASTOMOSIS,44625,HCPCS,975,RC,,,,both,3784,2648.8,,,,,,,,,,,,,,,,,,,Other,1100.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,957.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,957.31,1100.91, CLOSE OSTOMY W/ RESECT + ANAST 90G,44626,HCPCS,975,RC,,,,both,5298,3708.6,,,,,,,,,,,,,,,,,,,Other,1739.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1512.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1512.79,1739.71, "ASST CLOSE OSTOMY W/ RESECT + ANAST,ASSISTANT SURGEON",44626,HCPCS,975,RC,80,,,both,1325,927.5,,,,,,,,,,,,,,,,,,,Other,278.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,242.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,242.05,278.35, FISTULA REPAIR ENTERO-CUTANEOUS 90,44640,HCPCS,975,RC,,,,both,4914,3439.8,,,,,,,,,,,,,,,,,,,Other,1531.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1331.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1331.53,1531.26, FISTULA CLOSURE ENTEROENTERIC/COLIC,44650,HCPCS,975,RC,,,,both,5099,3569.3,,,,,,,,,,,,,,,,,,,Other,1576.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1370.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1370.81,1576.44, FISTULA BOWEL RESECTION,44661,HCPCS,975,RC,,,,both,5142,3599.4,,,,,,,,,,,,,,,,,,,Other,1684.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1465.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1465.11,1684.87, EXCISION MECKEL'S DIVERTICULUM,44800,HCPCS,975,RC,,,,both,2498,1748.6,,,,,,,,,,,,,,,,,,,Other,870.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,757.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,757.33,870.94, APPENDECTOMY,44950,HCPCS,975,RC,,,,both,2152,1506.4,,,,,,,,,,,,,,,,,,,Other,720.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,626.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,626.8,720.82, APPENDECTOMY DURING MAJOR PROCEDURE,44955,HCPCS,975,RC,,,,both,530,371,,,,,,,,,,,,,,,,,,,Other,90.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,78.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,78.84,90.67, "ASST APPENDECTOMY DURING MAJOR PROC,ASSISTANT SURGEON",44955,HCPCS,975,RC,80,,,both,133,93.1,,,,,,,,,,,,,,,,,,,Other,14.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,12.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.61,14.5, APPENDECTOMY/RUPTURED/PERITONITIS,44960,HCPCS,975,RC,,,,both,3166,2216.2,,,,,,,,,,,,,,,,,,,Other,985.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,856.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,856.73,985.23, LAP APPENDECTOMY 90G,44970,HCPCS,975,RC,,,,both,2096,1467.2,,,,,,,,,,,,,,,,,,,Other,683.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,594.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,594.17,683.3, "ASST LAP APPENDECTOMY,ASSISTANT SURGEON",44970,HCPCS,975,RC,80,,,both,524,366.8,,,,,,,,,,,,,,,,,,,Other,109.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,95.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,95.07,109.33, UNLISTED LAPAROSCOPY APPENDIX,44979,HCPCS,975,RC,,,,both,3200,2240,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, INCISION DRAINGAGE SUBMUC RECT ABSC 10G,45005,HCPCS,975,RC,,,,both,730,511,,,,,,,,,,,,,,,,,,,Other,197.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,344.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,197.65,344.6, I/D RECTAL ABSCES 90,45020,HCPCS,975,RC,,,,both,1776,1243.2,,,,,,,,,,,,,,,,,,,Other,634.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,552.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,552.16,634.98, BX ANORECTAL WALL G90,45100,HCPCS,975,RC,,,,both,1015,710.5,,,,,,,,,,,,,,,,,,,Other,343.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,298.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,298.27,343.01, PROCTECTOMY ABD-PERIN COMPL COLOST,45110,HCPCS,975,RC,,,,both,6582,4607.4,,,,,,,,,,,,,,,,,,,Other,1954.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1699.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1699.41,1954.32, EXC RECTUM TRANSABD,45111,HCPCS,975,RC,,,,both,4077,2853.9,,,,,,,,,,,,,,,,,,,Other,1186.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1031.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1031.57,1186.3, "ASST EXC RECTUM TRANSABD,ASSISTANT SURGEON",45111,HCPCS,975,RC,80,,,both,1019,713.3,,,,,,,,,,,,,,,,,,,Other,189.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,165.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,165.05,189.81, PART PROTECT W ANAST ABD OR TRANS,45114,HCPCS,975,RC,,,,both,6665,4665.5,,,,,,,,,,,,,,,,,,,Other,2032.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1767.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1767.03,2032.08, PROCTECTOMY COMPLETE W ANASTOMOSIS,45120,HCPCS,975,RC,,,,both,5638,3946.6,,,,,,,,,,,,,,,,,,,Other,1793.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1559.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1559.82,1793.79, PROCTOCOLECTOMY W/MULT BX ANAST,45121,HCPCS,975,RC,,,,both,5851,4095.7,,,,,,,,,,,,,,,,,,,Other,1956.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1700.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1700.92,1956.05, EXCISION RECTAL STRICTURE,45150,HCPCS,975,RC,,,,both,1402,981.4,,,,,,,,,,,,,,,,,,,Other,485.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,422.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,422.52,485.89, RECTAL TUMOR TRANSANAL W/O MUSC 90,45171,HCPCS,975,RC,,,,both,2087,1460.9,,,,,,,,,,,,,,,,,,,Other,693.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,603.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,603.27,693.76, "ASST RECTAL TUMOR TRANSANAL W/O MUSC 90,ASSISTANT SURGEON",45171,HCPCS,975,RC,80,,,both,522,365.4,,,,,,,,,,,,,,,,,,,Other,111,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,96.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,96.52,111, TRANS ANAL EXC RECTAL TUMOR W/MUSC 90,45172,HCPCS,975,RC,,,,both,2849,1994.3,,,,,,,,,,,,,,,,,,,Other,909.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,790.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,790.91,909.55, PROCTOSIGMOIDOSCOPY DIAGNOSTIC,45300,HCPCS,975,RC,,,,both,374,261.8,,,,,,,,,,,,,,,,,,,Other,52.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,137.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,52.14,137.97, PROCTOSIG WITH DILATION,45303,HCPCS,975,RC,,,,both,2262,1583.4,,,,,,,,,,,,,,,,,,,Other,92.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,926.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,92.59,926.27, PROCTOSIGMOIDOSCOPY WITH BIOPSY,45305,HCPCS,975,RC,,,,both,532,372.4,,,,,,,,,,,,,,,,,,,Other,79.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,184.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,79.7,184.97, ENDOSCOPY W/REMOV OF SNGL TUMR POLY,45309,HCPCS,975,RC,,,,both,589,412.3,,,,,,,,,,,,,,,,,,,Other,102.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,221.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,102.2,221.26, PROCTOSIG W/REM MULTI LESIONS,45315,HCPCS,975,RC,,,,both,646,452.2,,,,,,,,,,,,,,,,,,,Other,119.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,238.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,119.06,238.61, SIGMOIDOSCOPY W/DECOMPRESS/VOLVULUS,45321,HCPCS,975,RC,,,,both,437,305.9,,,,,,,,,,,,,,,,,,,Other,116.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,101.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,101.6,116.84, FLEXI SIGMOIDOSCOPY DIAGNOSTIC,45330,HCPCS,975,RC,,,,both,484,338.8,,,,,,,,,,,,,,,,,,,Other,60.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,197.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.96,197.35, FLEXI SIGMOIDOSCOPY BIOPSY,45331,HCPCS,975,RC,,,,both,591,413.7,,,,,,,,,,,,,,,,,,,Other,75.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,295.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,75.8,295.13, FLEXI SIGMOIDOSCOPY POLYPECT HOT,45333,HCPCS,975,RC,,,,both,761,532.7,,,,,,,,,,,,,,,,,,,Other,99.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,338.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,99.34,338.32, FLEXISIG WITH CONTROL BLEEDING,45334,HCPCS,975,RC,,,,both,826,578.2,,,,,,,,,,,,,,,,,,,Other,120.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,497.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,120.72,497.07, FLEXISIG WITH INJECTION,45335,HCPCS,975,RC,,,,both,698,488.6,,,,,,,,,,,,,,,,,,,Other,71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,299.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,71,299.33, FLEXI SIGM W/DECOMPRESS OF VOLVULUS,45337,HCPCS,975,RC,,,,both,661,462.7,,,,,,,,,,,,,,,,,,,Other,115.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,100.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,100.3,115.35, SIGMOID W/REM OF POL/TUM/LES SNARE,45338,HCPCS,975,RC,,,,both,968,677.6,,,,,,,,,,,,,,,,,,,Other,124.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,310.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,124.7,310.76, FLEXISIG WITH DILATION,45340,HCPCS,975,RC,,,,both,1002,701.4,,,,,,,,,,,,,,,,,,,Other,82.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,461.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,82.73,461.05, COLONOSCOPY SCREENING,45378,HCPCS,975,RC,,,,both,1136,795.2,,,,,,,,,,,,,,,,,,,Other,189.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,356.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,189.88,356.08, COLONOSCOPY WITH REMOVAL FB,45379,HCPCS,975,RC,,,,both,1476,1033.2,,,,,,,,,,,,,,,,,,,Other,241.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,451.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,241.82,451.15, COLONOSCOPY WITH BIOPSY (DIAGNOSTIC),45380,HCPCS,975,RC,,,,both,1341,938.7,,,,,,,,,,,,,,,,,,,Other,204.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,448.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,204.49,448.27, COLONOSCOPY WITH INJECTION SUBMUC,45381,HCPCS,975,RC,,,,both,1338,936.6,,,,,,,,,,,,,,,,,,,Other,204.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,457.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,204.49,457.53, COLONOSCOPY W/ CONTROL BLEEDING,45382,HCPCS,975,RC,,,,both,1645,1151.5,,,,,,,,,,,,,,,,,,,Other,260.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,676.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,260.46,676.86, COLONOSCOPY REMOVAL TUMOR HOT BX,45384,HCPCS,975,RC,,,,both,1383,968.1,,,,,,,,,,,,,,,,,,,Other,237.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,506.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,237.22,506.92, COLONOSCOPY W/RM POLYS SNARE,45385,HCPCS,975,RC,,,,both,1516,1061.2,,,,,,,,,,,,,,,,,,,Other,257,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,470.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,257,470.93, COLONOSCOPY W ABLATION TUM/POLYP,45388,HCPCS,975,RC,,,,both,1484,1038.8,,,,,,,,,,,,,,,,,,,Other,275.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1454.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,275.65,1454.32, COLONOSCOPY W/HEMORROID BANDING,45398,HCPCS,975,RC,,,,both,1809,1266.3,,,,,,,,,,,,,,,,,,,Other,243.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,831.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,243.59,831.94, RECTOCELE REPAIR 90G,45560,HCPCS,975,RC,,,,both,2349,1644.3,,,,,,,,,,,,,,,,,,,Other,735.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,639.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,639.7,735.65, RECTAL PRE-SACRAL EXPLOR DRAIN REP,45562,HCPCS,975,RC,,,,both,3690,2583,,,,,,,,,,,,,,,,,,,Other,1327.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1154.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1154.74,1327.96, EXPLOR REPAIR-RECTAL INJUR W/COLOST,45563,HCPCS,975,RC,,,,both,5133,3593.1,,,,,,,,,,,,,,,,,,,Other,1867.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1623.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1623.8,1867.37, DILATION OF ANAL SPHINCTER 10G,45905,HCPCS,975,RC,,,,both,614,429.8,,,,,,,,,,,,,,,,,,,Other,191.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,166.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,166.68,191.68, DILATION RECTAL STRICTURE,45910,HCPCS,975,RC,,,,both,787,550.9,,,,,,,,,,,,,,,,,,,Other,214.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,186.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,186.39,214.35, REMOVE FECAL IMPACT FB W ANES 10G,45915,HCPCS,975,RC,,,,both,1021,714.7,,,,,,,,,,,,,,,,,,,Other,263.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,383.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,263.86,383.06, ANORECTAL EXAM U/ANESTHESIA DX,45990,HCPCS,975,RC,,,,both,405,283.5,,,,,,,,,,,,,,,,,,,Other,116.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,101.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,101.52,116.75, PLACEMENT OF SETON,46020,HCPCS,975,RC,,,,both,895,626.5,,,,,,,,,,,,,,,,,,,Other,128.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,112.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,112.03,128.84, REMOVAL ANAL SETON,46030,HCPCS,975,RC,,,,both,449,314.3,,,,,,,,,,,,,,,,,,,Other,93.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,263.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,93.41,263.23, I&D ISCHIO &/OR PERIRECTAL ABS 90G,46040,HCPCS,975,RC,,,,both,1702,1191.4,,,,,,,,,,,,,,,,,,,Other,493.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,604.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,493.99,604.39, INCISION & DRAINAGE SUBMUCOSAL TRANSANAL,46045,HCPCS,975,RC,,,,both,1328,929.6,,,,,,,,,,,,,,,,,,,Other,509.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,443.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,443.34,509.84, I&D PERIRECTAL ABSCESS SUPERFICIAL 10G,46050,HCPCS,975,RC,,,,both,686,480.2,,,,,,,,,,,,,,,,,,,Other,116.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,247.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,116.38,247.64, I&D ISCHIORECTAL/INTRM ABSC 90G,46060,HCPCS,975,RC,,,,both,1666,1166.2,,,,,,,,,,,,,,,,,,,Other,555.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,483.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,483.12,555.59, ANAL SPHINCTEROTOMY 10G,46080,HCPCS,975,RC,,,,both,774,541.8,,,,,,,,,,,,,,,,,,,Other,174.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,299.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,174.36,299.84, INCISION EXTERNAL HEMORRHOID 10G,46083,HCPCS,975,RC,,,,both,539,377.3,,,,,,,,,,,,,,,,,,,Other,122.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,211.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,122.14,211.7, FISSURECTOMY 90G,46200,HCPCS,975,RC,,,,both,1219,853.3,,,,,,,,,,,,,,,,,,,Other,383.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,497.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,383.92,497.6, PAPILLECTOMY OR EXC SINGLE TAG ANUS,46220,HCPCS,975,RC,,,,both,616,431.2,,,,,,,,,,,,,,,,,,,Other,135.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,257.19,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,135.27,257.19, HEMORRHOID BANDING 10G,46221,HCPCS,975,RC,,,,both,782,547.4,,,,,,,,,,,,,,,,,,,Other,219.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,305.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,219.11,305.59, EXCISION EXT HEMMORRHOID 10G,46230,HCPCS,975,RC,,,,both,799,559.3,,,,,,,,,,,,,,,,,,,Other,191.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,323.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,191.26,323.8, HEMORHOIDECTOMY EXTERNAL COMPLETE 90G,46250,HCPCS,975,RC,,,,both,1239,867.3,,,,,,,,,,,,,,,,,,,Other,361.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,509.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,361.98,509.91, HEMORROIDECTOMY INT EXT SIMPLE 90G,46255,HCPCS,975,RC,,,,both,1469,1028.3,,,,,,,,,,,,,,,,,,,Other,398.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,552.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,398.98,552.85, EXC HEMORR IN AND EX W FISSURECTOMY,46257,HCPCS,975,RC,,,,both,1405,983.5,,,,,,,,,,,,,,,,,,,Other,466.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,405.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,405.31,466.11, HEMORR IN&EXT COMP OR EXTENS G90,46260,HCPCS,975,RC,,,,both,1696,1187.2,,,,,,,,,,,,,,,,,,,Other,547.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,476.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,476.34,547.79, HEMORRHOIDECTOMY IN/EX COMP FISS 90G,46261,HCPCS,975,RC,,,,both,1780,1246,,,,,,,,,,,,,,,,,,,Other,590.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,513.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,513.32,590.32, EXC HEMORRHOIDECTOMY W/FISTULECTOMY 90G,46262,HCPCS,975,RC,,,,both,1880,1316,,,,,,,,,,,,,,,,,,,Other,680.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,591.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,591.76,680.53, FISTULECTOMY SUBQ EXC PERI RECT 90G,46270,HCPCS,975,RC,,,,both,1536,1075.2,,,,,,,,,,,,,,,,,,,Other,459.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,571.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,459.91,571.47, FISTULECTOMY INTERSPHINCTERIC 90G,46275,HCPCS,975,RC,,,,both,1653,1157.1,,,,,,,,,,,,,,,,,,,Other,478.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,600.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,478.77,600.12, FISTULECT COMPL OR MULT W/WO PLACE,46280,HCPCS,975,RC,,,,both,1776,1243.2,,,,,,,,,,,,,,,,,,,Other,545.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,474.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,474.26,545.4, EXC THROMBOSED HEM EXTERNAL 10,46320,HCPCS,975,RC,,,,both,619,433.3,,,,,,,,,,,,,,,,,,,Other,123.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,218.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,123.44,218.51, CHEMODENERVATION OF INTERNAL ANAL SPHINC,46505,HCPCS,975,RC,,,,both,977,683.9,,,,,,,,,,,,,,,,,,,Other,277.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,327.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,277.24,327.15, ANOSCOPY,46600,HCPCS,975,RC,,,,both,304,212.8,,,,,,,,,,,,,,,,,,,Other,45.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,118.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,45.31,118.6, ANOSCOPY WITH DILATION,46604,HCPCS,975,RC,,,,both,1473,1031.1,,,,,,,,,,,,,,,,,,,Other,71.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,625,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,71.95,625, ANOSCOPY DIAGNOSTIC WITH BIOPSY,46606,HCPCS,975,RC,,,,both,746,522.2,,,,,,,,,,,,,,,,,,,Other,81.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,282.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,81.94,282.23, ANOSCOPY DX W/REMOVAL LESION,46610,HCPCS,975,RC,,,,both,631,441.7,,,,,,,,,,,,,,,,,,,Other,88.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,282.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,88.07,282.2, TRANSANAL REMOVAL LESION 00,46611,HCPCS,975,RC,,,,both,531,371.7,,,,,,,,,,,,,,,,,,,Other,86.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,223.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,86.03,223.94, ANOSCOPY REMOVAL MULTIPLE LESIONS,46612,HCPCS,975,RC,,,,both,865,605.5,,,,,,,,,,,,,,,,,,,Other,107.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,340.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,107.46,340.6, ENDOSCOPY W/ABLATION OF TUMORS/POLY,46615,HCPCS,975,RC,,,,both,530,371,,,,,,,,,,,,,,,,,,,Other,96.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,180.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,96.18,180.16, ANOPLASTY,46700,HCPCS,975,RC,,,,both,2306,1614.2,,,,,,,,,,,,,,,,,,,Other,728.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,633.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,633.35,728.36, ANORECTAL FISTULA REPAIR W/PLUG 90G,46707,HCPCS,975,RC,,,,both,1616,1131.2,,,,,,,,,,,,,,,,,,,Other,589.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,512.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,512.39,589.25, GRAFT FOR INCONTINENCE OR PROLAPSE,46753,HCPCS,975,RC,,,,both,1833,1283.1,,,,,,,,,,,,,,,,,,,Other,717.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,624.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,624.15,717.77, ANAL LESION DESTRUCTION ELECTRODESICCATI,46910,HCPCS,975,RC,,,,both,768,537.6,,,,,,,,,,,,,,,,,,,Other,147.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,277.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,147.12,277.06, EXC LESION ANAL SURGICAL 10G,46922,HCPCS,975,RC,,,,both,833,583.1,,,,,,,,,,,,,,,,,,,Other,153.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,321.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,153.06,321.07, DESTRUCTION ANAL LESIONS 10,46924,HCPCS,975,RC,,,,both,1536,1075.2,,,,,,,,,,,,,,,,,,,Other,196.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,573.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,196.49,573.11, HET (HEMORRHOID ENERGY THERAPY,46930,HCPCS,975,RC,,,,both,637,445.9,,,,,,,,,,,,,,,,,,,Other,172.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,230.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,172.74,230.9, ANAL FISSURE CURETTAGE/CAUTERY 10,46940,HCPCS,975,RC,,,,both,882,617.4,,,,,,,,,,,,,,,,,,,Other,156.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,273.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,156.63,273.66, LIGATION INTERNAL HEMORRHOID,46945,HCPCS,975,RC,,,,both,891,623.7,,,,,,,,,,,,,,,,,,,Other,387.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,336.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,336.93,387.47, LIGATION INT HEMORRHOIDS MULTIPLE,46946,HCPCS,975,RC,,,,both,926,648.2,,,,,,,,,,,,,,,,,,,Other,425.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,370.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,370.14,425.65, PERCUTANEOUS NEEDLE LIVER BX NA 00G,47000,HCPCS,975,RC,,,,both,727,508.9,,,,,,,,,,,,,,,,,,,Other,88.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,265.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,88.13,265.82, LIVER BX NEEDLE ADDITIONAL PROCECDU,47001,HCPCS,975,RC,,,,both,406,284.2,,,,,,,,,,,,,,,,,,,Other,112.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,98.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,98.05,112.76, LIVER BIOPSY WEDGE 90,47100,HCPCS,975,RC,,,,both,2845,1991.5,,,,,,,,,,,,,,,,,,,Other,957.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,832.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,832.41,957.27, HEPATECTOMY PARTIAL LOBECTOMY,47120,HCPCS,975,RC,,,,both,9000,6300,,,,,,,,,,,,,,,,,,,Other,2587.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2249.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2249.71,2587.16, "ASST HEPATECTOMY PARTIAL LOBECTOMY,ASSISTANT SURGEON",47120,HCPCS,975,RC,80,,,both,2250,1575,,,,,,,,,,,,,,,,,,,Other,413.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,359.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,359.95,413.94, LIVER LOBECTOMY LEFT,47125,HCPCS,975,RC,,,,both,11844,8290.8,,,,,,,,,,,,,,,,,,,Other,3402.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2958.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2958.47,3402.25, HEPATECTOMY RESEC OF LIVER;RT LOBEC,47130,HCPCS,975,RC,,,,both,12849,8994.3,,,,,,,,,,,,,,,,,,,Other,3640.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3165.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3165.61,3640.45, MARSUPIALIZATION LIVER CYST,47300,HCPCS,975,RC,,,,both,3895,2726.5,,,,,,,,,,,,,,,,,,,Other,1272.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1106.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1106.24,1272.18, CHOLEDOCOTOMY CHOLEDOCHOSTOMY,47420,HCPCS,975,RC,,,,both,4605,3223.5,,,,,,,,,,,,,,,,,,,Other,1476.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1284.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1284.07,1476.68, SPHINCTEROPLASTY W/EXTRACT STONES,47460,HCPCS,975,RC,,,,both,4408,3085.6,,,,,,,,,,,,,,,,,,,Other,1426.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1240.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1240.79,1426.91, CHOLECYSTOTOMY 90G,47480,HCPCS,975,RC,,,,both,2855,1998.5,,,,,,,,,,,,,,,,,,,Other,982.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,853.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,853.97,982.07, CHOLECYSTOSTOMY W/IMAGING GUIDANCE CATH,47490,HCPCS,975,RC,,,,both,1795,1256.5,,,,,,,,,,,,,,,,,,,Other,334.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,290.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,290.51,334.09, T-TUBE CHOLANGIOGRAM,47531,HCPCS,975,RC,,,,both,522,365.4,,,,,,,,,,,,,,,,,,,Other,71.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,363.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,71.17,363.13, PLACEMENT OF BILLIARY DRAINAGE CATHETER,47533,HCPCS,975,RC,,,,both,1516,1061.2,,,,,,,,,,,,,,,,,,,Other,264.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1021.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,264.49,1021.06, REMOVAL OF T-TUBE INCL CHOLANGIOGRAM,47537,HCPCS,975,RC,,,,both,696,487.2,,,,,,,,,,,,,,,,,,,Other,97.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,423.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,97.02,423.26, PLACEMENT OF STENT INOT BILE DUCT W/O SE,47539,HCPCS,975,RC,,,,both,2202,1541.4,,,,,,,,,,,,,,,,,,,Other,429.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2157.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,429.52,2157.96, "ASST PLACEMENT OF STENT INOT BILE DUCT W,ASSISTANT SURGEON",47539,HCPCS,975,RC,80,,,both,551,385.7,,,,,,,,,,,,,,,,,,,Other,68.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,539.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,68.73,539.98, BILIARY ENDOSCOPY INTRAOPERATIVE (CHOLED,47550,HCPCS,975,RC,,,,both,636,445.2,,,,,,,,,,,,,,,,,,,Other,176.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,153.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,153.18,176.16, "ASST BILIARY ENDOSCOPY,ASSISTANT SURGEON",47550,HCPCS,975,RC,80,,,both,159,111.3,,,,,,,,,,,,,,,,,,,Other,28.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.51,28.18, BILIARY ENDOSCOPY T-TUBE,47552,HCPCS,975,RC,,,,both,1237,865.9,,,,,,,,,,,,,,,,,,,Other,300.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,261.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,261.37,300.58, BILLIARY ENDO PERCUTANEOUS VIA T-TUBE W/,47554,HCPCS,975,RC,,,,both,2094,1465.8,,,,,,,,,,,,,,,,,,,Other,467.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,406.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,406.45,467.41, DILATION BILE DUCT,47555,HCPCS,975,RC,,,,both,1535,1074.5,,,,,,,,,,,,,,,,,,,Other,356.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,310.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,310.35,356.9, LAP CHOLE 90,47562,HCPCS,975,RC,,,,both,2758,1930.6,,,,,,,,,,,,,,,,,,,Other,749,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,651.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,651.31,749, "ASST LAP CHOLE,ASSISTANT SURGEON",47562,HCPCS,975,RC,80,,,both,690,483,,,,,,,,,,,,,,,,,,,Other,119.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,104.21,119.84, LAP CHOLE W/ IOC 90G,47563,HCPCS,975,RC,,,,both,2960,2072,,,,,,,,,,,,,,,,,,,Other,812.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,706.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,706.74,812.74, LAP CHOLE W/ EXPL COMMON DUCT 90G,47564,HCPCS,975,RC,,,,both,3881,2716.7,,,,,,,,,,,,,,,,,,,Other,1262.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1097.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1097.6,1262.24, "ASST LAP CHOLE W/IOC,ASSISTANT SURGEON",47563,HCPCS,975,RC,80,,,both,740,518,,,,,,,,,,,,,,,,,,,Other,130.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.08,130.04, "ASST LAP CHOLE W/EXPLORATION COMMON DUCT,ASSISTANT SURGEON",47564,HCPCS,975,RC,80,,,both,970,679,,,,,,,,,,,,,,,,,,,Other,201.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,175.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,175.62,201.96, CHOLECYSTECTOMY OPEN 90G,47600,HCPCS,975,RC,,,,both,3719,2603.3,,,,,,,,,,,,,,,,,,,Other,1201.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1045.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1045.1,1201.86, "ASST OPEN CHOLECYSTECTOMY,ASSISTANT SURGEON",47600,HCPCS,975,RC,80,,,both,930,651,,,,,,,,,,,,,,,,,,,Other,192.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,167.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,167.22,192.3, CHOLECYSTECTOMY WITH IOC 90G,47605,HCPCS,975,RC,,,,both,3613,2529.1,,,,,,,,,,,,,,,,,,,Other,1265.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1100.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1100.22,1265.25, "ASST CHOLEWITH LOC,ASSISTANT SURGEON",47605,HCPCS,975,RC,80,,,both,903,632.1,,,,,,,,,,,,,,,,,,,Other,202.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,176.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,176.04,202.44, CHOLECYSTECTOMY W/COMMON DUCT EXPLORATIO,47610,HCPCS,975,RC,,,,both,4317,3021.9,,,,,,,,,,,,,,,,,,,Other,1404.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1221.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1221.02,1404.17, "ASST CHOLE W/EXPLOR COMMON DUCT 90G,ASSISTANT SURGEON",47610,HCPCS,975,RC,80,,,both,1079,755.3,,,,,,,,,,,,,,,,,,,Other,224.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,195.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,195.36,224.66, EXCIS W/CHOLEDOCHOENTEROSTOMY,47612,HCPCS,975,RC,,,,both,4337,3035.9,,,,,,,,,,,,,,,,,,,Other,1428.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1242.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1242.55,1428.94, CHOLECYSTECTOMY W/TRANSDUO SPHIN,47620,HCPCS,975,RC,,,,both,4707,3294.9,,,,,,,,,,,,,,,,,,,Other,1541.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1340.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1340.01,1541.01, BILE DUCT EXPLORATION FOR ATRESIA,47700,HCPCS,975,RC,,,,both,3668,2567.6,,,,,,,,,,,,,,,,,,,Other,1195.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1039.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1039.54,1195.47, EXC CYST CHOLEDOCHO,47715,HCPCS,975,RC,,,,both,5080,3556,,,,,,,,,,,,,,,,,,,Other,1496.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1301.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1301.08,1496.23, CHOLECYSTOENTEROSTOMY; DIRECT,47720,HCPCS,975,RC,,,,both,3623,2536.1,,,,,,,,,,,,,,,,,,,Other,1303.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1133.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1133.45,1303.47, CHOLECYSTOENTEROSTOMY ROUX EN Y,47740,HCPCS,975,RC,,,,both,4121,2884.7,,,,,,,,,,,,,,,,,,,Other,1477.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1284.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1284.75,1477.47, ANASTOMOSIS EX HEP BIL DUCTS GI TRC,47760,HCPCS,975,RC,,,,both,7600,5320,,,,,,,,,,,,,,,,,,,Other,2490.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2165.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2165.97,2490.87, DUODEN SWITCH ROUX/Y CHOLDOCHENT,47780,HCPCS,975,RC,,,,both,8825,6177.5,,,,,,,,,,,,,,,,,,,Other,2742.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2385.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2385.21,2742.99, SUTURE OF EXTRAHPEATIC BIL DUCT,47900,HCPCS,975,RC,,,,both,4978,3484.6,,,,,,,,,,,,,,,,,,,Other,1550.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1348.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1348.11,1550.32, BIOPSY OF PANCREAS 90G,48100,HCPCS,975,RC,,,,both,3211,2247.7,,,,,,,,,,,,,,,,,,,Other,1001.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,871.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,871.09,1001.76, PANCREATECTOMY SUBT W/WO SPLENECTOM,48140,HCPCS,975,RC,,,,both,6009,4206.3,,,,,,,,,,,,,,,,,,,Other,1740.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1513.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1513.38,1740.39, "ASST PANCREATECTOMY WITH/WITHOUT SPLENEC,ASSISTANT SURGEON",48140,HCPCS,975,RC,80,,,both,1502,1051.4,,,,,,,,,,,,,,,,,,,Other,278.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,242.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,242.14,278.47, WHIPPLE PANCREATECTOMY GAST DUOD CH,48150,HCPCS,975,RC,,,,both,12137,8495.9,,,,,,,,,,,,,,,,,,,Other,3439.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2990.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2990.53,3439.1, "ASST WHIPPLE PANCREATECTOMY GAST DUOD CH,ASSISTANT SURGEON",48150,HCPCS,975,RC,80,,,both,3034,2123.8,,,,,,,,,,,,,,,,,,,Other,550.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,478.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,478.48,550.26, WHIPPLE W/O PANCREATOJEJUNOSTOMY,48152,HCPCS,975,RC,,,,both,10453,7317.1,,,,,,,,,,,,,,,,,,,Other,3216.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2796.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2796.99,3216.54, WHIPPLE PANCREATECTOMY PROXIMAL SUBTOTAL,48153,HCPCS,975,RC,,,,both,12692,8884.4,,,,,,,,,,,,,,,,,,,Other,3440.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2991.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2991.85,3440.63, TOTAL PANCREATECTOMY,48155,HCPCS,975,RC,,,,both,7421,5194.7,,,,,,,,,,,,,,,,,,,Other,2033.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1768.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1768.17,2033.4, PSEUDOCYST PANCREAS EXTERNAL DRAIN,48510,HCPCS,975,RC,,,,both,4030,2821,,,,,,,,,,,,,,,,,,,Other,1238.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1076.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1076.96,1238.5, PANCREATIC CYSTO-JEJUNOSTOMY,48520,HCPCS,975,RC,,,,both,3756,2629.2,,,,,,,,,,,,,,,,,,,Other,1238.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1076.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1076.79,1238.32, ROUX-EN-Y,48540,HCPCS,975,RC,,,,both,4565,3195.5,,,,,,,,,,,,,,,,,,,Other,1465.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1274.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1274.62,1465.81, EXPLORATORY LAPAROTOMY 90G,49000,HCPCS,975,RC,,,,both,2859,2001.3,,,,,,,,,,,,,,,,,,,Other,863.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,750.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,750.96,863.61, "ASST LAPAROTOMY DIAGNOSTIC EXPLORATORY,ASSISTANT SURGEON",49000,HCPCS,975,RC,80,,,both,715,500.5,,,,,,,,,,,,,,,,,,,Other,138.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,120.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,120.16,138.18, REOPEN RECENT LAPAROTOMY NO MOD/RED 90G,49002,HCPCS,975,RC,,,,both,3784,2648.8,,,,,,,,,,,,,,,,,,,Other,1163.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1011.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1011.56,1163.29, "ASST REOPEN RECENT LAPAROTOMY,ASSISTANT SURGEON",49002,HCPCS,975,RC,80,,,both,946,662.2,,,,,,,,,,,,,,,,,,,Other,186.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,161.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,161.85,186.12, INCISION EXPLOR RETROPERITONEAL,49010,HCPCS,975,RC,,,,both,3691,2583.7,,,,,,,,,,,,,,,,,,,Other,1035.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,900.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,900.57,1035.65, DRAINAGE PERITONEAL ABSCESS 90G,49020,HCPCS,975,RC,,,,both,5539,3877.3,,,,,,,,,,,,,,,,,,,Other,1771.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1540.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1540.32,1771.36, "ASST DRAINAGE PERITONEAL ABSCESS,ASSISTANT SURGEON",49020,HCPCS,975,RC,80,,,both,1385,969.5,,,,,,,,,,,,,,,,,,,Other,283.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,246.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,246.45,283.42, DRAINAGE ABSCESS SUBDIA SUBPHRENIC,49040,HCPCS,975,RC,,,,both,3210,2247,,,,,,,,,,,,,,,,,,,Other,1140.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,992.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,992.17,1140.99, "ASST DRAINAGE ABSCESS SUBDIA SUBPHRENIC,ASSISTANT SURGEON",49040,HCPCS,975,RC,80,,,both,800,560,,,,,,,,,,,,,,,,,,,Other,182.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,158.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,158.75,182.56, DRAINAGE RETROPERITONEAL ABSCESS,49060,HCPCS,975,RC,,,,both,3839,2687.3,,,,,,,,,,,,,,,,,,,Other,1218.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1059.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1059.74,1218.71, DRAINAGE EXTRAPERITONEAL LYMPHOCELE TO P,49062,HCPCS,975,RC,,,,both,2692,1884.4,,,,,,,,,,,,,,,,,,,Other,871.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,757.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,757.85,871.53, ABD PARACENTESIS W/O IMAGING,49082,HCPCS,975,RC,,,,both,560,392,,,,,,,,,,,,,,,,,,,Other,82.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,227.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,82.06,227.06, PARACENTESIS ABD W/IMAG GUIDANCE 00,49083,HCPCS,975,RC,,,,both,608,425.6,,,,,,,,,,,,,,,,,,,Other,107.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,264.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,107.06,264.35, PERITONEAL LAVAGE W/IMAGING GUIDANCE,49084,HCPCS,975,RC,,,,both,410,287,,,,,,,,,,,,,,,,,,,Other,116.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,101.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,101.11,116.28, BIOPSY NEEDLE ABDOMINAL/RETROPERIT,49180,HCPCS,975,RC,,,,both,652,456.4,,,,,,,,,,,,,,,,,,,Other,83.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,161.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,83.14,161.05, SCLEROTHARAPY OF FLUID COLLECT (EG LYMPH,49185,HCPCS,975,RC,,,,both,422,295.4,,,,,,,,,,,,,,,,,,,Other,123.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,413.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,123.1,413.56, UMBILICUS EXCISION,49250,HCPCS,975,RC,,,,both,1988,1391.6,,,,,,,,,,,,,,,,,,,Other,664.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,578.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,578.03,664.73, OMENTECTOMY RESECTION 90G,49255,HCPCS,975,RC,,,,both,2527,1768.9,,,,,,,,,,,,,,,,,,,Other,883.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,768.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,768.45,883.72, "ASST OMENTECTOMY RESECTION,ASSISTANT SURGEON",49255,HCPCS,975,RC,80,,,both,632,442.4,,,,,,,,,,,,,,,,,,,Other,141.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,122.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,122.95,141.39, LAP DX ABD PERIT W/WO SPEC 10G,49320,HCPCS,975,RC,,,,both,1388,971.6,,,,,,,,,,,,,,,,,,,Other,371.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,323.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,323.45,371.97, "ASST LAP DIAGNOSTIC W/WO SPECIMEN,ASSISTANT SURGEON",49320,HCPCS,975,RC,80,,,both,347,242.9,,,,,,,,,,,,,,,,,,,Other,59.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,51.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,51.75,59.52, LAP DX W BX 10G,49321,HCPCS,975,RC,,,,both,1544,1080.8,,,,,,,,,,,,,,,,,,,Other,387.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,336.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,336.57,387.06, LAP DX W/ ASP CYST/CAVITY,49322,HCPCS,975,RC,,,,both,1547,1082.9,,,,,,,,,,,,,,,,,,,Other,419.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,364.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,364.87,419.61, "AXXT DX LAPAROSCOPY W/BX,ASSISTANT SURGEON",49321,HCPCS,975,RC,80,,,both,386,270.2,,,,,,,,,,,,,,,,,,,Other,61.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,53.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,53.85,61.93, LAP W/INSERT INTRAPERIT CATH 10,49324,HCPCS,975,RC,,,,both,1387,970.9,,,,,,,,,,,,,,,,,,,Other,436.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,379.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,379.34,436.24, LAP REPOSIION PERITONEAL CATH 10,49325,HCPCS,975,RC,,,,both,1420,994,,,,,,,,,,,,,,,,,,,Other,464.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,403.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,403.61,464.16, "ASST LAP DX W/ASP CYST/CAVITY,ASSISTANT SURGEON",49322,HCPCS,975,RC,80,,,both,387,270.9,,,,,,,,,,,,,,,,,,,Other,67.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,58.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,58.38,67.14, "ASST LAP INTRAPERITONEAL CATH,ASSISTANT SURGEON",49324,HCPCS,975,RC,80,,,both,347,242.9,,,,,,,,,,,,,,,,,,,Other,69.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,60.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,60.69,69.8, IMAGE GUIDED FLUID COLLECTION DRAINAGE B,49405,HCPCS,975,RC,,,,both,1226,858.2,,,,,,,,,,,,,,,,,,,Other,194.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,769.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,194.54,769.56, IMAGE GUIDED FLUID COLLECTION BY CATH PE,49406,HCPCS,975,RC,,,,both,1179,825.3,,,,,,,,,,,,,,,,,,,Other,194.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,768.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,194.54,768.97, INSERTION OF TUNNELED INTRAPERITONEAL CA,49418,HCPCS,975,RC,,,,both,1346,942.2,,,,,,,,,,,,,,,,,,,Other,203.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,861.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,203.15,861.02, REMOVE TUN PERIT CATH DIALYSIS 10,49422,HCPCS,975,RC,,,,both,1302,911.4,,,,,,,,,,,,,,,,,,,Other,243.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,212.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,212.04,243.85, EXCHNG DRAIN CATH W/RAD GUIDANCE,49423,HCPCS,975,RC,,,,both,821,574.7,,,,,,,,,,,,,,,,,,,Other,71.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,499.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,71.12,499.06, INJ W/ CONTRAST ABSCESS/CYST,49424,HCPCS,975,RC,,,,both,387,270.9,,,,,,,,,,,,,,,,,,,Other,37.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,156.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,37.13,156.6, DENVER PERITONEAL VENOUS SHUNT,49425,HCPCS,975,RC,,,,both,3003,2102.1,,,,,,,,,,,,,,,,,,,Other,884.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,769.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,769.51,884.93, REVISION PERITONEAL-VENOUS SHUNT,49426,HCPCS,975,RC,,,,both,2205,1543.5,,,,,,,,,,,,,,,,,,,Other,760.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,661.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,661.55,760.78, INJ CONTRAST MEDIA EVAL SHUNT,49427,HCPCS,975,RC,,,,both,214,149.8,,,,,,,,,,,,,,,,,,,Other,41.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.5,41.97, REMOVAL PERITONEAL-VENOUS SHUNT,49429,HCPCS,975,RC,,,,both,1685,1179.5,,,,,,,,,,,,,,,,,,,Other,518.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,450.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,450.73,518.34, "ASST G-TUBE PERC PLCMENT RAD SUP/INTERP,ASSISTANT SURGEON",49440,HCPCS,975,RC,80,,,both,399,279.3,,,,,,,,,,,,,,,,,,,Other,33.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,116.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,33.06,116.05, J-TUBE PERC PLCMENT RAD SUP/INTERP 10G,49441,HCPCS,975,RC,,,,both,1857,1299.9,,,,,,,,,,,,,,,,,,,Other,255.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,905.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,255.54,905.99, G-TUBE PERC PLCMENT RAD SUP/INTERP 10G,49440,HCPCS,975,RC,,,,both,1594,1115.8,,,,,,,,,,,,,,,,,,,Other,206.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,725.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,206.59,725.35, "ASST J-TUBE PERC PLCMENT RAD SUP/INTERP,ASSISTANT SURGEON",49441,HCPCS,975,RC,80,,,both,464,324.8,,,,,,,,,,,,,,,,,,,Other,40.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,144.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,40.89,144.96, GASTROST TUBE REPLACE W/FLOURO,49450,HCPCS,975,RC,,,,both,536,375.2,,,,,,,,,,,,,,,,,,,Other,66.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,511.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,66.11,511.74, REPLACE G-TUBE OR J-TUBE,49451,HCPCS,975,RC,,,,both,731,511.7,,,,,,,,,,,,,,,,,,,Other,89.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,548.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,89.36,548.09, REPLACE GASTRO-JEJUNOSTOMY TUBE PERC UND,49452,HCPCS,975,RC,,,,both,1121,784.7,,,,,,,,,,,,,,,,,,,Other,136.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,665.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,136.76,665.22, CONTRAST INJ FOR RAD EVAL OF G-TUBE J-TU,49465,HCPCS,975,RC,,,,both,228,159.6,,,,,,,,,,,,,,,,,,,Other,29.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,119.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,29.9,119.24, ING HERNIA REPAIR INITIAL <5YRS,49500,HCPCS,975,RC,,,,both,1528,1069.6,,,,,,,,,,,,,,,,,,,Other,480.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,417.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,417.41,480.02, HERNIA REPAIR INGUINAL INITIAL 90G,49505,HCPCS,975,RC,,,,both,1858,1300.6,,,,,,,,,,,,,,,,,,,Other,598.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,520.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,520.27,598.31, "ASST INGUINAL HERNIA REPAIR,ASSISTANT SURGEON",49505,HCPCS,975,RC,80,,,both,465,325.5,,,,,,,,,,,,,,,,,,,Other,95.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,83.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,83.24,95.73, "ASST INGUINAL HERNIA REPAIR,ASSISTANT PRACTITIONER",49505,HCPCS,975,RC,AS,,,both,465,325.5,,,,,,,,,,,,,,,,,,,Other,95.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,83.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,83.24,95.73, REPAIR INCARC INITL INGUINAL HERNIA,49507,HCPCS,975,RC,,,,both,2108,1475.6,,,,,,,,,,,,,,,,,,,Other,670.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,582.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,582.93,670.37, "ASST INCARC INGUINAL HERNIA REPAIR,ASSISTANT SURGEON",49507,HCPCS,975,RC,80,,,both,527,368.9,,,,,,,,,,,,,,,,,,,Other,107.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,93.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,93.27,107.26, HERNIA INGUINAL RECURRENT REPAIR 90G,49520,HCPCS,975,RC,,,,both,2221,1554.7,,,,,,,,,,,,,,,,,,,Other,720.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,626.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,626.42,720.38, REPAIR INCARC RECUR INGUINAL HERNIA 90G,49521,HCPCS,975,RC,,,,both,2518,1762.6,,,,,,,,,,,,,,,,,,,Other,812.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,706.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,706.93,812.97, "ASST HERNIA INGUINAL RECURRENT REPAIR,ASSISTANT SURGEON",49520,HCPCS,975,RC,80,,,both,555,388.5,,,,,,,,,,,,,,,,,,,Other,115.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,100.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,100.22,115.26, "ASST ING HERNIA RECURRENT INCARCER,ASSISTANT SURGEON",49521,HCPCS,975,RC,80,,,both,630,441,,,,,,,,,,,,,,,,,,,Other,130.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.11,130.08, INGUINAL HERNIA REPAIR SLIDING 90G,49525,HCPCS,975,RC,,,,both,2025,1417.5,,,,,,,,,,,,,,,,,,,Other,654.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,569.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,569.41,654.82, "ASST INGUINAL HERNIA REPAIR SLIDING,ASSISTANT SURGEON",49525,HCPCS,975,RC,80,,,both,506,354.2,,,,,,,,,,,,,,,,,,,Other,104.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,91.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,91.1,104.77, "ASST (PA) INGUINAL HENIA REPAIR SLIDING,ASSISTANT PRACTITIONER",49525,HCPCS,975,RC,AS,,,both,506,354.2,,,,,,,,,,,,,,,,,,,Other,104.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,91.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,91.1,104.77, REPAIR LUMBAR HERNIA,49540,HCPCS,975,RC,,,,both,2303,1612.1,,,,,,,,,,,,,,,,,,,Other,762.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,663.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,663.15,762.62, REPAIR FEMORAL HERNIA GROIN INCISIN,49550,HCPCS,975,RC,,,,both,1963,1374.1,,,,,,,,,,,,,,,,,,,Other,659.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,573.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,573.59,659.64, REPAIR FEM HERNIA INCARC OR STRANG,49553,HCPCS,975,RC,,,,both,2188,1531.6,,,,,,,,,,,,,,,,,,,Other,719.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,625.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,625.96,719.85, "ASST REPAIR FEM HERNIA INCARC OR STRANG,ASSISTANT SURGEON",49553,HCPCS,975,RC,80,,,both,547,382.9,,,,,,,,,,,,,,,,,,,Other,115.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,100.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,100.16,115.18, REPAIR RECURRENT FEM HERNIA REDUCIB,49555,HCPCS,975,RC,,,,both,2109,1476.3,,,,,,,,,,,,,,,,,,,Other,690.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,600.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,600.51,690.6, HERNIA FEMORAL RECURR INCARC,49557,HCPCS,975,RC,,,,both,2389,1672.3,,,,,,,,,,,,,,,,,,,Other,821.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,714.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,714.55,821.73, REPAIR ANTERIOR ABDML HERNIA ANY APPRCH,49591,HCPCS,975,RC,,,,both,1500,1050,,,,,,,,,,,,,,,,,,,Other,380.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,330.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,330.66,380.26, "REPAIR ANTERIOR ABDML HERNIA ANY APPRCH,ASSISTANT SURGEON",49591,HCPCS,975,RC,80,,,both,375,262.5,,,,,,,,,,,,,,,,,,,Other,60.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,52.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,52.91,60.84, REPAIR ANTERIOR ABD HERNIA INCARCERATED,49592,HCPCS,975,RC,,,,both,2000,1400,,,,,,,,,,,,,,,,,,,Other,529.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,460.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,460.35,529.4, REPAIR ANTERIOR ABD HERNIA W/MESH 3-10 C,49593,HCPCS,975,RC,,,,both,1475,1032.5,,,,,,,,,,,,,,,,,,,Other,636.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,553.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,553.81,636.88, REPAIR ANTERIOR ABD HERNIA W/MESH 3 TO 1,49594,HCPCS,975,RC,,,,both,1923,1346.1,,,,,,,,,,,,,,,,,,,Other,829.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,721.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,721.32,829.52, REPAIR ANTERIOR ABD HERNIA W/MESH > 10CM,49595,HCPCS,975,RC,,,,both,1983,1388.1,,,,,,,,,,,,,,,,,,,Other,854.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,742.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,742.81,854.24, REPAIR ANTERIOR ABD HERNIA W/MESH > 10CM,49596,HCPCS,975,RC,,,,both,2594,1815.8,,,,,,,,,,,,,,,,,,,Other,1139.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,990.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,990.45,1139.01, "REPAIR ANTERIOR ABD HERNIA INCARCERATED,ASSISTANT SURGEON",49592,HCPCS,975,RC,80,,,both,500,350,,,,,,,,,,,,,,,,,,,Other,84.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,73.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,73.66,84.7, "ASST REPAIR ANTERIOR ABD HERNIA INCARCER,ASSISTANT PRACTITIONER",49592,HCPCS,975,RC,AS,,,both,500,350,,,,,,,,,,,,,,,,,,,Other,84.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,73.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,73.66,84.7, "REPAIR ANTERIOR ABD HERNIA W/MESH 3-10 C,ASSISTANT SURGEON",49593,HCPCS,975,RC,80,,,both,369,258.3,,,,,,,,,,,,,,,,,,,Other,101.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,88.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,88.61,101.9, "REPAIR ANTERIOR ABD HERNIA W/MESH 3 TO 1,ASSISTANT SURGEON",49594,HCPCS,975,RC,80,,,both,481,336.7,,,,,,,,,,,,,,,,,,,Other,132.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,115.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,115.41,132.72, "REPAIR ANTERIOR ABD HERNIA W/MESH > 10CM,ASSISTANT SURGEON",49595,HCPCS,975,RC,80,,,both,496,347.2,,,,,,,,,,,,,,,,,,,Other,136.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,118.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,118.85,136.68, "ASST REPAIR ANTERIOR ABD HERNIA W/MESH >,ASSISTANT SURGEON",49596,HCPCS,975,RC,80,,,both,650,455,,,,,,,,,,,,,,,,,,,Other,182.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,158.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,158.48,182.24, REPAIR ANTERIOR ABDNL WALL HERNIA < 3 CM,49613,HCPCS,975,RC,,,,both,1084,758.8,,,,,,,,,,,,,,,,,,,Other,467.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,406.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,406.53,467.51, "REPAIR ANTERIOR ABDNL WALL HERNIA < 3 CM,ASSISTANT SURGEON",49613,HCPCS,975,RC,80,,,both,271,189.7,,,,,,,,,,,,,,,,,,,Other,74.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,65.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.04,74.8, REPAIR RECRNT ABDOMINAL HERNIA 3 - 5CM R,49615,HCPCS,975,RC,,,,both,2230,1561,,,,,,,,,,,,,,,,,,,Other,708.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,616.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,616.12,708.53, REPAIR ANTERIOR ABDNL WALL HERNIA 3 - 10,49616,HCPCS,975,RC,,,,both,2000,1400,,,,,,,,,,,,,,,,,,,Other,952.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,828.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,828.02,952.23, "REPAIR RECRNT ABDOMINAL HERNIA 3 - 5CM R,ASSISTANT SURGEON",49615,HCPCS,975,RC,80,,,both,558,390.6,,,,,,,,,,,,,,,,,,,Other,113.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,98.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,98.58,113.37, REPAIR ANTERIOR ABD HERNIA RECURRENT >10,49618,HCPCS,975,RC,,,,both,3194,2235.8,,,,,,,,,,,,,,,,,,,Other,1375.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1196.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1196.5,1375.98, "RPR ANTERIOR ABDNL WALL HERNIA 3-10 CM I,ASSISTANT SURGEON",49616,HCPCS,975,RC,80,,,both,500,350,,,,,,,,,,,,,,,,,,,Other,152.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,132.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,132.49,152.36, "REPAIR ANTERIOR ABD HERNIA RECURRENT >10,ASSISTANT SURGEON",49618,HCPCS,975,RC,80,,,both,799,559.3,,,,,,,,,,,,,,,,,,,Other,220.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,191.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,191.44,220.16, REMOVAL OF TOTAL/NEAR NON-INFECTED MESH,49623,HCPCS,975,RC,,,,both,505,353.5,,,,,,,,,,,,,,,,,,,Other,224.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,195.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,195.3,224.6, "REMOVAL OF TOTAL/NEAR NON-INFECTED MESH,ASSISTANT SURGEON",49623,HCPCS,975,RC,80,,,both,126,88.2,,,,,,,,,,,,,,,,,,,Other,35.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,31.25,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.25,35.94, LAPAROSCOPY SURIGCAL; REPAIR INITIAL ING,49650,HCPCS,975,RC,,,,both,1636,1145.2,,,,,,,,,,,,,,,,,,,Other,496.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,431.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,431.88,496.65, LAP INGUINAL HERNIA REPAIR RECURRENT,49651,HCPCS,975,RC,,,,both,2072,1450.4,,,,,,,,,,,,,,,,,,,Other,645.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,561.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,561.22,645.4, "ASST LAPAROSCOPY SURGICAL; REPAIR INITIA,ASSISTANT SURGEON",49650,HCPCS,975,RC,80,,,both,409,286.3,,,,,,,,,,,,,,,,,,,Other,79.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,69.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,69.1,79.47, "LAP INGUINAL HERNIA REPAIR RECURRENT ASS,ASSISTANT SURGEON",49651,HCPCS,975,RC,80,,,both,518,362.6,,,,,,,,,,,,,,,,,,,Other,103.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,89.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,89.8,103.26, SUTURE SECONDARY OF AB WALL FOR DEHISCEN,49900,HCPCS,975,RC,,,,both,2669,1868.3,,,,,,,,,,,,,,,,,,,Other,937.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,815.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,815.18,937.46, "SUTURE SECONDARY OF AB WALL FOR DEHISCEN,ASSISTANT SURGEON",49900,HCPCS,975,RC,80,,,both,667,466.9,,,,,,,,,,,,,,,,,,,Other,149.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,130.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,130.43,149.99, OMENTAL FLAP INTRA-ABDOMINAL.,49905,HCPCS,975,RC,,,,both,1494,1045.8,,,,,,,,,,,,,,,,,,,Other,381.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,331.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,331.48,381.2, "ASST OMENTAL FLAP INTRA-ABDOMINAL,ASSISTANT SURGEON",49905,HCPCS,975,RC,80,,,both,374,261.8,,,,,,,,,,,,,,,,,,,Other,61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,53.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,53.04,61, RENAL BX PERC NEEDLE TROCAR TRU-CUT,50200,HCPCS,975,RC,,,,both,1069,748.3,,,,,,,,,,,,,,,,,,,Other,126.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,451.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,126.89,451.92, RENAL BIOPS;BY SURG EXPOS OF KIDNEY,50205,HCPCS,975,RC,,,,both,3311,2317.7,,,,,,,,,,,,,,,,,,,Other,845.91,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,735.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,735.57,845.91, RADICAL NEPHRECTOMY 90G,50220,HCPCS,975,RC,,,,both,4261,2982.7,,,,,,,,,,,,,,,,,,,Other,1125.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,978.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,978.42,1125.19, "ASST RADICAL NEPHRECTOMY,ASSISTANT SURGEON",50220,HCPCS,975,RC,80,,,both,1065,745.5,,,,,,,,,,,,,,,,,,,Other,180.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,156.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,156.55,180.03, NEPHRECTOMY W PARTIAL URETERECT,50225,HCPCS,975,RC,,,,both,5000,3500,,,,,,,,,,,,,,,,,,,Other,1227.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1067.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1067.21,1227.29, RADICAL NEPHRECTOMY W LYMPH/THROMBE 90G,50230,HCPCS,975,RC,,,,both,5143,3600.1,,,,,,,,,,,,,,,,,,,Other,1331.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1158.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1158.04,1331.74, "ASST RADICAL NEPHRECTOMY W LYMPH/THROMBE,ASSISTANT SURGEON",50230,HCPCS,975,RC,80,,,both,1286,900.2,,,,,,,,,,,,,,,,,,,Other,213.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,185.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,185.29,213.08, NEPHREC W URETEREC W BLADDER CUFF,50234,HCPCS,975,RC,,,,both,5095,3566.5,,,,,,,,,,,,,,,,,,,Other,1348.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1172.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1172.52,1348.4, PARTIAL NEPHRECTOMY,50240,HCPCS,975,RC,,,,both,5187,3630.9,,,,,,,,,,,,,,,,,,,Other,1380.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1200.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1200.27,1380.32, NEPH TUBE REMOVAL W/FLOURO,50389,HCPCS,975,RC,,,,both,525,367.5,,,,,,,,,,,,,,,,,,,Other,53.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,360.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,53.52,360.04, RENAL CYST ASPIRATION,50390,HCPCS,975,RC,,,,both,519,363.3,,,,,,,,,,,,,,,,,,,Other,94.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,82.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,82.23,94.57, PLACEMENT OF NEPHROSTOMY CATH,50432,HCPCS,975,RC,,,,both,1371,959.7,,,,,,,,,,,,,,,,,,,Other,206.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,793.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,206.13,793.38, LAP NEPHRECTOMY RADICAL 90,50545,HCPCS,975,RC,,,,both,5248,3673.6,,,,,,,,,,,,,,,,,,,Other,1378.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1198.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1198.75,1378.56, "ASST LAP NEPHRECTOMY RADICAL,ASSISTANT SURGEON",50545,HCPCS,975,RC,80,,,both,1312,918.4,,,,,,,,,,,,,,,,,,,Other,220.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,191.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,191.8,220.57, LITHOTRIPSEY,50590,HCPCS,975,RC,,,,both,2846,1992.2,,,,,,,,,,,,,,,,,,,Other,597.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,733.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,597.45,733.49, INJ URETEROGRAPHY/URETEROPYELOG,50684,HCPCS,975,RC,,,,both,446,312.2,,,,,,,,,,,,,,,,,,,Other,52.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,118.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,52.5,118.57, URETEROPYELOGRAPHY,50690,HCPCS,975,RC,,,,both,374,261.8,,,,,,,,,,,,,,,,,,,Other,70.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,110.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,70.56,110.37, URETEROLYSIS,50715,HCPCS,975,RC,,,,both,5465,3825.5,,,,,,,,,,,,,,,,,,,Other,1322.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1149.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1149.69,1322.14, URETEROURETEROSTOMY,50760,HCPCS,975,RC,,,,both,4312,3018.4,,,,,,,,,,,,,,,,,,,Other,1202.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1045.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1045.34,1202.14, REPAIR URETEROILEAL COND INCLD BOWE,50820,HCPCS,975,RC,,,,both,5250,3675,,,,,,,,,,,,,,,,,,,Other,1369.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1190.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1190.63,1369.23, CYSTOSTOMY,51040,HCPCS,975,RC,,,,both,1302,911.4,,,,,,,,,,,,,,,,,,,Other,308.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,268.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,268.55,308.83, CATH SUPRAPUBIC,51102,HCPCS,975,RC,,,,both,841,588.7,,,,,,,,,,,,,,,,,,,Other,146.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,230.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,146.26,230.28, EXCIS OF URACHAL CYST W/WO UMB HERN,51500,HCPCS,975,RC,,,,both,2219,1553.3,,,,,,,,,,,,,,,,,,,Other,665.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,578.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,578.93,665.76, CYSTOSTOMY EXC BLADDER DIVERTICULUM,51525,HCPCS,975,RC,,,,both,3228,2259.6,,,,,,,,,,,,,,,,,,,Other,893.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,777.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,777.2,893.78, CYSTECTOMY PARTIAL SIMPLE,51550,HCPCS,975,RC,,,,both,3552,2486.4,,,,,,,,,,,,,,,,,,,Other,1012.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,880.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,880.52,1012.59, CYSTECTOMY COMPLICATED,51555,HCPCS,975,RC,,,,both,4733,3313.1,,,,,,,,,,,,,,,,,,,Other,1312.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1140.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1140.95,1312.08, "ASST CYSTECTOMY COMPLICATED,ASSISTANT SURGEON",51555,HCPCS,975,RC,80,,,both,1183,828.1,,,,,,,,,,,,,,,,,,,Other,209.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,182.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,182.55,209.94, CYSTECTOMY W ILEAL CONDUIT,51590,HCPCS,975,RC,,,,both,7766,5436.2,,,,,,,,,,,,,,,,,,,Other,1992.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1732.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1732.69,1992.59, CYSTECTOMY W CONDUIT LYMPHADENECTOM,51595,HCPCS,975,RC,,,,both,9273,6491.1,,,,,,,,,,,,,,,,,,,Other,2252.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1958.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1958.53,2252.31, INJECT PROCED FOR CYSTOGRAPHY,51600,HCPCS,975,RC,,,,both,812,568.4,,,,,,,,,,,,,,,,,,,Other,43.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,189.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,43.51,189.95, INJEC RETRO URETHROCYSTOGRAPHY,51610,HCPCS,975,RC,,,,both,542,379.4,,,,,,,,,,,,,,,,,,,Other,65.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,120.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.74,120.22, BLADDER IRRIG SIMPLE LAVAGE INSTILL,51700,HCPCS,975,RC,,,,both,286,200.2,,,,,,,,,,,,,,,,,,,Other,30.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,73.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.45,73.1, CATH URETHRA STRAIGHT I/O,51701,HCPCS,975,RC,,,,both,189,132.3,,,,,,,,,,,,,,,,,,,Other,26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,43.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26,43.53, CATH SIMPLE BLADDER (FOLEY),51702,HCPCS,975,RC,,,,both,257,179.9,,,,,,,,,,,,,,,,,,,Other,26.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,61.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.69,61.46, CATH BLADDER COMPLICATED (FOLEY),51703,HCPCS,975,RC,,,,both,467,326.9,,,,,,,,,,,,,,,,,,,Other,78.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,146.19,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,78.75,146.19, CYSTOSTOMY TUBE CHANGE SIMPLE,51705,HCPCS,975,RC,,,,both,344,240.8,,,,,,,,,,,,,,,,,,,Other,54.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,95.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,54.27,95.61, CYSTOSTOMY TUBE CHANGE COMPLICATED,51710,HCPCS,975,RC,,,,both,482,337.4,,,,,,,,,,,,,,,,,,,Other,83.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,133.19,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,83.75,133.19, CYSTOPLASTY W/WO WEDGE RESEC OF POS,51800,HCPCS,975,RC,,,,both,4220,2954,,,,,,,,,,,,,,,,,,,Other,1076.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,936.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,936.08,1076.49, MMP ANT VESICOURETROPEXY/URETHROPEX,51840,HCPCS,975,RC,,,,both,2489,1742.3,,,,,,,,,,,,,,,,,,,Other,716.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,623,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,623,716.45, CYSTORRHAPHY SUTURE BLADDER SIMPLE,51860,HCPCS,975,RC,,,,both,2701,1890.7,,,,,,,,,,,,,,,,,,,Other,790.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,687.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,687.6,790.73, CYSTOURETHROSCOPY,52000,HCPCS,975,RC,,,,both,701,490.7,,,,,,,,,,,,,,,,,,,Other,82.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,201.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,82.98,201.56, CYSTO W/IRRIGATION & EVACUATION OF MULTI,52001,HCPCS,975,RC,,,,both,1211,847.7,,,,,,,,,,,,,,,,,,,Other,294.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,404.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,294.16,404.92, CYSTO W/URETEROPYELOGRAPHY,52005,HCPCS,975,RC,,,,both,924,646.8,,,,,,,,,,,,,,,,,,,Other,137.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,263.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,137.7,263.79, CYSTO W/BRUSH BX OF URETER AND OR RENAL,52007,HCPCS,975,RC,,,,both,1467,1026.9,,,,,,,,,,,,,,,,,,,Other,171.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,403,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,171.67,403, CYSTOURETHORSCOPY WITH BIOPSY(S),52204,HCPCS,975,RC,,,,both,1308,915.6,,,,,,,,,,,,,,,,,,,Other,147.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,332.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,147.2,332.42, CYSTOURETHROSCOPY WITH BIOPSY,52214,HCPCS,975,RC,,,,both,2791,1953.7,,,,,,,,,,,,,,,,,,,Other,178.07,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,669.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,178.07,669.76, CYSTOURETHROSCOPY W/FULGURATION/TRMT OF,52224,HCPCS,975,RC,,,,both,2839,1987.3,,,,,,,,,,,,,,,,,,,Other,205.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,701.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,205.7,701.86, CYSTOURETHROSCOPY W/FULGURTION SMALL BLA,52234,HCPCS,975,RC,,,,both,1117,781.9,,,,,,,,,,,,,,,,,,,Other,251.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,218.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,218.89,251.72, CYSTO W/FULGURATION AND/OR RESECTION OF,52235,HCPCS,975,RC,,,,both,1452,1016.4,,,,,,,,,,,,,,,,,,,Other,295.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,257.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,257.29,295.88, CYSTO W/FULGURATION &/OR RESECTION OF LA,52240,HCPCS,975,RC,,,,both,2108,1475.6,,,,,,,,,,,,,,,,,,,Other,401.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,349.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,349.14,401.52, CYSTOURETHROSCOPY W/DILATION OF BLADDER,52260,HCPCS,975,RC,,,,both,793,555.1,,,,,,,,,,,,,,,,,,,Other,216.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,187.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,187.87,216.05, CYSTOURETHROSCOPY W/DILATION OF BLADDER,52265,HCPCS,975,RC,,,,both,1107,774.9,,,,,,,,,,,,,,,,,,,Other,168.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,326.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,168.15,326.12, CYSTO W/ DILATION URETHRAL STRICT,52281,HCPCS,975,RC,,,,both,1103,772.1,,,,,,,,,,,,,,,,,,,Other,158.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,292.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,158.15,292.92, CYSTOURETHROSCOPY W/DILATION & DRUG DELI,52284,HCPCS,975,RC,,,,both,1103,772.1,,,,,,,,,,,,,,,,,,,Other,169.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1080.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,169.63,1080.94, CYSTOURETHROSCOPY; W/ REMOVAL OF STENT C,52310,HCPCS,975,RC,,,,both,971,679.7,,,,,,,,,,,,,,,,,,,Other,156.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,282.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,156.28,282.63, CYSTOURETHEROSCOPY W/RMVL FOREIGN BODY C,52315,HCPCS,975,RC,,,,both,1590,1113,,,,,,,,,,,,,,,,,,,Other,282.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,438.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,282.5,438.12, REMOVE BLADDER STONES,52317,HCPCS,975,RC,,,,both,2608,1825.6,,,,,,,,,,,,,,,,,,,Other,355.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,813.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,355.31,813.72, CYSTOURETHROSCOPY W/INSERTION OF URETERA,52332,HCPCS,975,RC,,,,both,1558,1090.6,,,,,,,,,,,,,,,,,,,Other,161.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,349.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,161.47,349.01, CYSTO W/TRMT OF URETERAL STRICTURE DILAT,52341,HCPCS,975,RC,,,,both,1077,753.9,,,,,,,,,,,,,,,,,,,Other,291,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,253.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,253.05,291, CYSTO W/TRTMNT OF URETEROPELVIC JUNCTION,52345,HCPCS,975,RC,,,,both,1474,1031.8,,,,,,,,,,,,,,,,,,,Other,403.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,351.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,351.08,403.75, CYSTOSCOPY W/URETEROSCOPY AND/OR PYELOSC,52351,HCPCS,975,RC,,,,both,1345,941.5,,,,,,,,,,,,,,,,,,,Other,310,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,269.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,269.57,310, CYSTOURETHEROSCOPY W/REMOVAL OF CALCULUS,52352,HCPCS,975,RC,,,,both,1567,1096.9,,,,,,,,,,,,,,,,,,,Other,362.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,315.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,315.65,362.99, CYSTO WITH URETEROSCOPY &/OR PYELOSCOPY;,52353,HCPCS,975,RC,,,,both,1791,1253.7,,,,,,,,,,,,,,,,,,,Other,400.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,348.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,348.13,400.34, CYSTO W/URETEROSCOPY W/BX & OR FLUGURATI,52354,HCPCS,975,RC,,,,both,1890,1323,,,,,,,,,,,,,,,,,,,Other,427.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,371.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,371.75,427.52, "CYSTO W/URETEROSCOPY W/BX & OR FLUGURATI,ASSISTANT PRACTITIONER",52354,HCPCS,975,RC,AS,,,both,473,331.1,,,,,,,,,,,,,,,,,,,Other,68.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,59.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,59.48,68.4, CYSTO/URETERO W/LITHOTRIPSY INCLUDING ST,52356,HCPCS,975,RC,,,,both,1760,1232,,,,,,,,,,,,,,,,,,,Other,426.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,370.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,370.56,426.14, CYSTOURETHROSCOPY W/INCISION OR RESECTIO,52400,HCPCS,975,RC,,,,both,1578,1104.6,,,,,,,,,,,,,,,,,,,Other,495,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,430.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,430.44,495, TRANSURETHERAL INCISION OF PROSTATE,52450,HCPCS,975,RC,,,,both,1669,1168.3,,,,,,,,,,,,,,,,,,,Other,499.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,434.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,434.47,499.64, TRANSURETHRAL RESECTION OF PROSTATE,52601,HCPCS,975,RC,,,,both,2795,1956.5,,,,,,,,,,,,,,,,,,,Other,604.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,525.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,525.26,604.05, TRANSURETHRAL RESECTION; RESIDUALL/REGRO,52630,HCPCS,975,RC,,,,both,1956,1369.2,,,,,,,,,,,,,,,,,,,Other,428.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,372.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,372.36,428.21, HOLMIUM LASER ENUCLEATION OF PROSTATE TR,52649,HCPCS,975,RC,,,,both,3736,2615.2,,,,,,,,,,,,,,,,,,,Other,757.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,658.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,658.63,757.42, BIOPSY OF URETHRA,53200,HCPCS,975,RC,,,,both,581,406.7,,,,,,,,,,,,,,,,,,,Other,149.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,163.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,149.21,163.82, EXC OF URETHERAL CARUNCLE,53265,HCPCS,975,RC,,,,both,801,560.7,,,,,,,,,,,,,,,,,,,Other,196.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,225.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,196.65,225.69, DILATION URETHRAL STICTURE MALE INI,53600,HCPCS,975,RC,,,,both,310,217,,,,,,,,,,,,,,,,,,,Other,65.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,88.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.28,88.14, DILATION OF URETHRAL STRICTURE UNDER GEN,53605,HCPCS,975,RC,,,,both,255,178.5,,,,,,,,,,,,,,,,,,,Other,65.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,56.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,56.87,65.4, DILATE URETH MALE INITIAL 00G,53620,HCPCS,975,RC,,,,both,404,282.8,,,,,,,,,,,,,,,,,,,Other,89.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,164.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,89.46,164.16, DILATION FEMALE URETHRA INITIAL,53660,HCPCS,975,RC,,,,both,239,167.3,,,,,,,,,,,,,,,,,,,Other,42.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,74.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,42.72,74.2, DILATION URETHR STRICTURE FEM SUBSQ,53661,HCPCS,975,RC,,,,both,223,156.1,,,,,,,,,,,,,,,,,,,Other,41.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,73.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,41.38,73.03, URETHRA DILATION FEMALE UNDER ANES,53665,HCPCS,975,RC,,,,both,161,112.7,,,,,,,,,,,,,,,,,,,Other,38.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,33.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,33.6,38.64, INSERTION OF TEMP PROSTATIC URETHERAL ST,53855,HCPCS,975,RC,,,,both,2256,1579.2,,,,,,,,,,,,,,,,,,,Other,84.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,594.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,84.27,594.17, SLIT PREPUCE,54001,HCPCS,975,RC,,,,both,653,457.1,,,,,,,,,,,,,,,,,,,Other,147.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,193.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,147.1,193.95, PENILE LESION ELECTRODES,54055,HCPCS,975,RC,,,,both,432,302.4,,,,,,,,,,,,,,,,,,,Other,96.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,131.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,96.78,131.08, EXC SURGICAL LESION PENIS G10,54060,HCPCS,975,RC,,,,both,633,443.1,,,,,,,,,,,,,,,,,,,Other,138.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,190.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,138.33,190.51, ELCTROSURG DESTR PENILE LESIONS,54065,HCPCS,975,RC,,,,both,733,513.1,,,,,,,,,,,,,,,,,,,Other,169,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,211.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,169,211.51, BIOPSY OF PENIS,54100,HCPCS,975,RC,,,,both,517,361.9,,,,,,,,,,,,,,,,,,,Other,117.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,191.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,117.84,191.23, CIRCUMCISION NOT NEWBORN W/O CLMP10,54161,HCPCS,975,RC,,,,both,723,506.1,,,,,,,,,,,,,,,,,,,Other,207.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,180.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,180.14,207.16, BIOPSY OF TESTIS INCISIONAL,54505,HCPCS,975,RC,,,,both,816,571.2,,,,,,,,,,,,,,,,,,,Other,220.34,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,191.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,191.6,220.34, SIMPLE ORCHIECTOMY W/WO PROSTHESIS,54520,HCPCS,975,RC,,,,both,1167,816.9,,,,,,,,,,,,,,,,,,,Other,349.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,303.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,303.7,349.26, ORCHIECTOMY RADICAL INQUINAL APPROA,54530,HCPCS,975,RC,,,,both,2167,1516.9,,,,,,,,,,,,,,,,,,,Other,537.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,467,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,467,537.05, "ASSISTANT ORCHIECTOMY RADICAL,ASSISTANT SURGEON",54530,HCPCS,975,RC,80,,,both,542,379.4,,,,,,,,,,,,,,,,,,,Other,85.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,74.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,74.72,85.93, FIXATION OF CONTRALATERAL TESTIS,54620,HCPCS,975,RC,,,,both,1081,756.7,,,,,,,,,,,,,,,,,,,Other,312.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,272.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,272.16,312.98, I&D EPIDIDYMIS TESTIS SCROTAL,54700,HCPCS,975,RC,,,,both,789,552.3,,,,,,,,,,,,,,,,,,,Other,228.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,198.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,198.85,228.68, EXC OF SPERMATOCELE W OR W/O EPIDIDYMECT,54840,HCPCS,975,RC,,,,both,1213,849.1,,,,,,,,,,,,,,,,,,,Other,340.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,295.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,295.85,340.23, PUNCTURE ASPIRATION OF HYDROCELE,55000,HCPCS,975,RC,,,,both,409,286.3,,,,,,,,,,,,,,,,,,,Other,88.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,120.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,88.35,120.76, EXCISION HYDROCELE UNILATERAL 90G,55040,HCPCS,975,RC,,,,both,1273,891.1,,,,,,,,,,,,,,,,,,,Other,358.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,312.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,312.04,358.85, HYDROCELE REPAIR BOTTLE TYPE,55060,HCPCS,975,RC,,,,both,1435,1004.5,,,,,,,,,,,,,,,,,,,Other,403.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,350.67,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,350.67,403.27, DRAINAGE SCROTAL WALL ABSCESS,55100,HCPCS,975,RC,,,,both,789,552.3,,,,,,,,,,,,,,,,,,,Other,185.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,236.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,185.88,236.93, VASECTOMY,55250,HCPCS,975,RC,,,,both,1359,951.3,,,,,,,,,,,,,,,,,,,Other,245.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,328.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,245.47,328.52, HYDROCELE EXC SPERM CORD,55500,HCPCS,975,RC,,,,both,1399,979.3,,,,,,,,,,,,,,,,,,,Other,420.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,366.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,366.08,420.99, SPERM CORD LESION EXCISION,55520,HCPCS,975,RC,,,,both,1509,1056.3,,,,,,,,,,,,,,,,,,,Other,523.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,455.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,455.63,523.98, "ASST SPERM CORD LESION EXCISION,ASSISTANT SURGEON",55520,HCPCS,975,RC,80,,,both,377,263.9,,,,,,,,,,,,,,,,,,,Other,83.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,72.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,72.9,83.84, EXC VARICOCELE,55530,HCPCS,975,RC,,,,both,1330,931,,,,,,,,,,,,,,,,,,,Other,372.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,323.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,323.78,372.35, VARICOCELE EXC WITH HERNIA REPAIR,55540,HCPCS,975,RC,,,,both,1975,1382.5,,,,,,,,,,,,,,,,,,,Other,635.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,552.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,552.24,635.08, INCISION AND DRAINAGE PERINEAL ABSC,56405,HCPCS,975,RC,,,,both,444,310.8,,,,,,,,,,,,,,,,,,,Other,131.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,140.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,131.4,140.26, BARTHOLIN GLAND INCISION DRAINAGE,56420,HCPCS,975,RC,,,,both,507,354.9,,,,,,,,,,,,,,,,,,,Other,113.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,171.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.55,171.97, MARSUPIALIZATION BARTHOLIN CYST,56440,HCPCS,975,RC,,,,both,728,509.6,,,,,,,,,,,,,,,,,,,Other,189.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,164.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,164.68,189.38, LABIAL ADHESION RELEASE LYSIS,56441,HCPCS,975,RC,,,,both,502,351.4,,,,,,,,,,,,,,,,,,,Other,159.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,176.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,159.46,176.02, VULVA LESION(S) DESTRUCTION,56501,HCPCS,975,RC,,,,both,434,303.8,,,,,,,,,,,,,,,,,,,Other,134.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,175.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,134.54,175.27, BIOPSY VULVA PERINEUM EXCIS/PUNCH,56605,HCPCS,975,RC,,,,both,300,210,,,,,,,,,,,,,,,,,,,Other,61.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,90.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,61.43,90.77, BIOPSY ADDL VULVA PERIN EXC/PUNCH,56606,HCPCS,975,RC,,,,both,154,107.8,,,,,,,,,,,,,,,,,,,Other,30.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.1,38.42, EXC BARTHOLIN'S CYST/GLAND 10G,56740,HCPCS,975,RC,,,,both,1080,756,,,,,,,,,,,,,,,,,,,Other,327.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,285.19,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,285.19,327.97, PERINEOPLASTY,56810,HCPCS,975,RC,,,,both,1053,737.1,,,,,,,,,,,,,,,,,,,Other,279.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,242.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,242.79,279.2, COLPOTOMY W DRAINAGE OF ABSCESS/HEM,57010,HCPCS,975,RC,,,,both,1497,1047.9,,,,,,,,,,,,,,,,,,,Other,470.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,409.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,409.39,470.79, VAG LESION DESTRUCTION,57061,HCPCS,975,RC,,,,both,445,311.5,,,,,,,,,,,,,,,,,,,Other,118.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,154.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,118.14,154.13, DESTR VAG LESIONS EXT,57065,HCPCS,975,RC,,,,both,755,528.5,,,,,,,,,,,,,,,,,,,Other,190.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,233.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,190.31,233.32, BX VAGINAL MUCOSA,57100,HCPCS,975,RC,,,,both,338,236.6,,,,,,,,,,,,,,,,,,,Other,69.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,102.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,69.35,102.16, VAGINAL BIOPSY MUCOSA EXTENSIVE,57105,HCPCS,975,RC,,,,both,561,392.7,,,,,,,,,,,,,,,,,,,Other,153.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,168.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,153.17,168.76, EXCISION VAGINAL CYST TUMOR 10G,57135,HCPCS,975,RC,,,,both,815,570.5,,,,,,,,,,,,,,,,,,,Other,193.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,234.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,193.08,234.84, COLPORRHAPHY VAGINAL SUTURE,57200,HCPCS,975,RC,,,,both,1118,782.6,,,,,,,,,,,,,,,,,,,Other,347.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,301.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,301.85,347.13, CYSTOCELE REPAIR ANT COLPORRHAPHY,57240,HCPCS,975,RC,,,,both,2126,1488.2,,,,,,,,,,,,,,,,,,,Other,632.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,549.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,549.98,632.47, RECTOCELE REPAIR POSTERIOR COLPORR 90G,57250,HCPCS,975,RC,,,,both,2175,1522.5,,,,,,,,,,,,,,,,,,,Other,633.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,551.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,551.12,633.8, COLPORRHAPHY ANT/POST,57260,HCPCS,975,RC,,,,both,2729,1910.3,,,,,,,,,,,,,,,,,,,Other,802.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,698,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,698,802.7, REPAIR ENTEROCELE VAGINAL APPROACH,57268,HCPCS,975,RC,,,,both,1848,1293.6,,,,,,,,,,,,,,,,,,,Other,525.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,456.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,456.56,525.04, ENTEROCELE REPAIR ABD APPROACH 90G,57270,HCPCS,975,RC,,,,both,2593,1815.1,,,,,,,,,,,,,,,,,,,Other,841.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,731.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,731.82,841.58, COLPOPEXY ABDOM APPROACH,57280,HCPCS,975,RC,,,,both,3240,2268,,,,,,,,,,,,,,,,,,,Other,1000.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,870.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,870.2,1000.73, "COLPOPEXY ABDOM APPROACH,ASSISTANT SURGEON",57280,HCPCS,975,RC,80,,,both,810,567,,,,,,,,,,,,,,,,,,,Other,160.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,139.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,139.23,160.11, SACROVAGINOPEXY,57282,HCPCS,975,RC,,,,both,2082,1457.4,,,,,,,,,,,,,,,,,,,Other,715.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,622.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,622.56,715.95, "ASST SACROVAGINOPEXY,ASSISTANT SURGEON",57282,HCPCS,975,RC,80,,,both,520.5,364.35,,,,,,,,,,,,,,,,,,,Other,114.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,99.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,99.61,114.55, VESICOVAGINAL FISTULA CLOSURE,57320,HCPCS,975,RC,,,,both,2414,1689.8,,,,,,,,,,,,,,,,,,,Other,581.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,505.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,505.45,581.28, PELVIC EXAM UNDER ANESTHESIA,57410,HCPCS,975,RC,,,,both,412,288.4,,,,,,,,,,,,,,,,,,,Other,112.26,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,97.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,97.62,112.26, REMOVAL IMPACTED FB VAGINAL W/ANEST,57415,HCPCS,975,RC,,,,both,562,393.4,,,,,,,,,,,,,,,,,,,Other,178.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,155.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,155.51,178.83, VAGINOSCOPY COLPOSCOPY,57420,HCPCS,975,RC,,,,both,424,296.8,,,,,,,,,,,,,,,,,,,Other,95.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,133.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,95.96,133.96, COLPOSCOPY VAG/CERV W/BX,57421,HCPCS,975,RC,,,,both,550,385,,,,,,,,,,,,,,,,,,,Other,129.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,177.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,129.69,177.93, LAAROSCOPY SURGICAL COLPOPEXY,57425,HCPCS,975,RC,,,,both,3293,2305.1,,,,,,,,,,,,,,,,,,,Other,1006.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,875.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,875.33,1006.63, "LAAROSCOPY SURGICAL COLPOPEXY ASSIST,ASSISTANT SURGEON",57425,HCPCS,975,RC,80,,,both,823,576.1,,,,,,,,,,,,,,,,,,,Other,161.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,140.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,140.05,161.06, VAGINOSCOPY COLPOSCOPY,57452,HCPCS,975,RC,,,,both,393,275.1,,,,,,,,,,,,,,,,,,,Other,96.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,122.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,96.03,122.06, COLPOSCOP CERVIX ENDOCERVCURETT 00G,57456,HCPCS,975,RC,,,,both,489,342.3,,,,,,,,,,,,,,,,,,,Other,105.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,146.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,105.73,146.93, EXCISION BIOPSY LESION CERVIX,57500,HCPCS,975,RC,,,,both,440,308,,,,,,,,,,,,,,,,,,,Other,79.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,143.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,79.42,143.18, ENDOCERVICAL CURETTAGE,57505,HCPCS,975,RC,,,,both,386,270.2,,,,,,,,,,,,,,,,,,,Other,111.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,141.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,111.36,141.06, CONIZATION OF CERVIX 90G,57520,HCPCS,975,RC,,,,both,1235,864.5,,,,,,,,,,,,,,,,,,,Other,313.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,350.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,313.93,350.69, ENDOMET ENDOCERV SAMPLING W/O DILAT,58100,HCPCS,975,RC,,,,both,383,268.1,,,,,,,,,,,,,,,,,,,Other,65.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,95.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.71,95.69, DILATION & CURRETAGE 10G,58120,HCPCS,975,RC,,,,both,997,697.9,,,,,,,,,,,,,,,,,,,Other,243.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,290.67,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,243.2,290.67, MYOMECTOMY EXC FIBROID TUMOR/UTERUS,58140,HCPCS,975,RC,,,,both,3355,2348.5,,,,,,,,,,,,,,,,,,,Other,953.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,828.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,828.71,953.01, HYSTERECTOMY TOTAL ABDOMINAL 90G,58150,HCPCS,975,RC,,,,both,3949,2764.3,,,,,,,,,,,,,,,,,,,Other,1098.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,955.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,955.62,1098.96, "ASST ABDOMINAL HYSTERECTOMY,ASSISTANT SURGEON",58150,HCPCS,975,RC,80,,,both,937,655.9,,,,,,,,,,,,,,,,,,,Other,175.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,152.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,152.9,175.83, TAH/BSO W BLADDER SUSPENSION,58152,HCPCS,975,RC,,,,both,4718,3302.6,,,,,,,,,,,,,,,,,,,Other,1283.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1115.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1115.71,1283.06, "ASST TAH/BSO W/BLADDER SUSPENSION,ASSISTANT SURGEON",58152,HCPCS,975,RC,80,,,both,1180,826,,,,,,,,,,,,,,,,,,,Other,205.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,178.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,178.52,205.29, TOTAL ABDOM HYSTER W/VAGINECTOMY,58200,HCPCS,975,RC,,,,both,5205,3643.5,,,,,,,,,,,,,,,,,,,Other,1487.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1293.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1293.09,1487.05, HYSTERECTOMY RADICAL,58210,HCPCS,975,RC,,,,both,7144,5000.8,,,,,,,,,,,,,,,,,,,Other,1984.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1725.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1725.9,1984.78, "ASST HYSTERECTOMY RADICAL,ASSISTANT SURGEON",58210,HCPCS,975,RC,80,,,both,1786,1250.2,,,,,,,,,,,,,,,,,,,Other,317.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,276.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,276.14,317.57, VAGINAL HYSTERECTOMY,58260,HCPCS,975,RC,,,,both,3121,2184.7,,,,,,,,,,,,,,,,,,,Other,867.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,754.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,754.11,867.23, UTERINE SUSPENSION W/WO SHORTEN LIG,58400,HCPCS,975,RC,,,,both,1818,1272.6,,,,,,,,,,,,,,,,,,,Other,478.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,415.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,415.93,478.32, TUBAL LIGATION UNI OR BILATERAL,58600,HCPCS,975,RC,,,,both,1411,987.7,,,,,,,,,,,,,,,,,,,Other,385.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,335.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,335.46,385.79, LAP LOA FEMALE 90G,58660,HCPCS,975,RC,,,,both,2556,1789.2,,,,,,,,,,,,,,,,,,,Other,740.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,644.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,644.14,740.76, LAP LOA W/EXC ADNEX 10G,58661,HCPCS,975,RC,,,,both,2652,1856.4,,,,,,,,,,,,,,,,,,,Other,691.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,601.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,601.33,691.53, LAP LOA W/EXC LESION OVARY,58662,HCPCS,975,RC,,,,both,2637,1845.9,,,,,,,,,,,,,,,,,,,Other,760.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,661.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,661.26,760.44, "ASST LAP LOA W/EXC ADNEX 10G,ASSISTANT SURGEON",58661,HCPCS,975,RC,80,,,both,663,464.1,,,,,,,,,,,,,,,,,,,Other,110.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,96.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,96.22,110.64, "ASST LAP LOA W/EXC LESION OVARY,ASSISTANT SURGEON",58662,HCPCS,975,RC,80,,,both,659,461.3,,,,,,,,,,,,,,,,,,,Other,121.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,105.8,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,105.8,121.67, LAP TUBAL LIGATION/FULGURATION,58670,HCPCS,975,RC,,,,both,1497,1047.9,,,,,,,,,,,,,,,,,,,Other,386.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,336.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,336.06,386.47, LAP TUBAL LIGATION CLIP/BAND/RING,58671,HCPCS,975,RC,,,,both,1552,1086.4,,,,,,,,,,,,,,,,,,,Other,386.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,336.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,336.06,386.47, LAP OVARY OVIDUCT UNLISTED #,58679,HCPCS,975,RC,,,,both,1800,1260,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, SALPINGO-OOPHORECTOMY,58720,HCPCS,975,RC,,,,both,2723,1906.1,,,,,,,,,,,,,,,,,,,Other,816.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,710.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,710.37,816.93, "ASST OOPHERECTOMY,ASSISTANT SURGEON",58720,HCPCS,975,RC,80,,,both,681,476.7,,,,,,,,,,,,,,,,,,,Other,130.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.66,130.71, LYSIS ADHESIONS SALPINGOLYSIS OVARI,58740,HCPCS,975,RC,,,,both,2696,1887.2,,,,,,,,,,,,,,,,,,,Other,967.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,841.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,841.66,967.92, DRAINAGE OVARIAN CYST ABDOM APP,58805,HCPCS,975,RC,,,,both,1501,1050.7,,,,,,,,,,,,,,,,,,,Other,439.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,382.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,382.22,439.55, WEDGE RESECTION BISECT OVARY,58920,HCPCS,975,RC,,,,both,2521,1764.7,,,,,,,,,,,,,,,,,,,Other,737.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,641.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,641.63,737.87, OVARIAN CYSTECTOMY,58925,HCPCS,975,RC,,,,both,2565,1795.5,,,,,,,,,,,,,,,,,,,Other,816.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,710.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,710.39,816.95, OOPHORECTOMY PARTOR TOT UNI OR BILA,58940,HCPCS,975,RC,,,,both,2055,1438.5,,,,,,,,,,,,,,,,,,,Other,597.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,519.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,519.47,597.39, OOPHORECTOMY MALIGNANCY BX WASH,58943,HCPCS,975,RC,,,,both,4350,3045,,,,,,,,,,,,,,,,,,,Other,1332.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1158.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1158.53,1332.31, RESECTION OVARIAN MALIGNANCY W METS,58951,HCPCS,975,RC,,,,both,6378,4464.6,,,,,,,,,,,,,,,,,,,Other,1571.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1366.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1366.9,1571.94, EXC OVARY OMENTUM ABD TUMOR,58952,HCPCS,975,RC,,,,both,6724,4706.8,,,,,,,,,,,,,,,,,,,Other,1793.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1559.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1559.38,1793.28, BILAT SALPOO W/OMENT TOTAL HYST,58953,HCPCS,975,RC,,,,both,8455,5918.5,,,,,,,,,,,,,,,,,,,Other,2184.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1899.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1899.97,2184.96, "ASST BILAT SALPOO W/OMENT TOTAL HYST,ASSISTANT SURGEON",58953,HCPCS,975,RC,80,,,both,2114,1479.8,,,,,,,,,,,,,,,,,,,Other,349.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,304,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,304,349.6, BIL SLPNGO-OPRCTMY W/TOTAL OMENTECTOMY T,58956,HCPCS,975,RC,,,,both,5629,3940.3,,,,,,,,,,,,,,,,,,,Other,1486.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1292.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1292.44,1486.31, "ASST BIL SLPNGO-OPRCTMY W/TOTAL OMENTECT,ASSISTANT SURGEON",58956,HCPCS,975,RC,80,,,both,1407,984.9,,,,,,,,,,,,,,,,,,,Other,237.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,206.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,206.79,237.81, RESECT RECUR GYN MALIGNANCY W/PELVIC LYM,58958,HCPCS,975,RC,,,,both,6641,4648.7,,,,,,,,,,,,,,,,,,,Other,1710.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1487.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1487.6,1710.74, "ASST BIL SLPNGO-OPRCTMY W/TOTAL OMENTECT,ASSISTANT PRACTITIONER",58956,HCPCS,975,RC,AS,,,both,1407,984.9,,,,,,,,,,,,,,,,,,,Other,237.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,206.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,206.79,237.81, LAP STAGING OV MALIGW/WO BX,58960,HCPCS,975,RC,,,,both,3884,2718.8,,,,,,,,,,,,,,,,,,,Other,1108.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,964.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,964.07,1108.67, "ASST RESECT RECUR GYN MALIGNANCY W/PELVI,ASSISTANT SURGEON",58958,HCPCS,975,RC,80,,,both,1660,1162,,,,,,,,,,,,,,,,,,,Other,273.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,238.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,238.01,273.71, EXC ECTOPIC SALP/OOPH,59120,HCPCS,975,RC,,,,both,2648,1853.6,,,,,,,,,,,,,,,,,,,Other,893.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,776.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,776.68,893.18, COMPLETED SURGICAL ABORTION,59812,HCPCS,975,RC,,,,both,1180,826,,,,,,,,,,,,,,,,,,,Other,335.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,363.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,335.37,363.04, SURG TX MISSED ABORTION 90,59820,HCPCS,975,RC,,,,both,1333,933.1,,,,,,,,,,,,,,,,,,,Other,413.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,431.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,413.71,431.47, THYROID CORE NEEDLE BIOPSY,60100,HCPCS,975,RC,,,,both,375,262.5,,,,,,,,,,,,,,,,,,,Other,76.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,105.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,76.5,105.08, PARTIAL THYROID LOBECTOMY UNILATER,60210,HCPCS,975,RC,,,,both,2591,1813.7,,,,,,,,,,,,,,,,,,,Other,757.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,658.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,658.86,757.7, TOTAL THYROID LOBECTOMY W/WO ISTH 90G,60220,HCPCS,975,RC,,,,both,2815,1970.5,,,,,,,,,,,,,,,,,,,Other,746.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,649.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,649.29,746.68, "ASST TOTAL THYROID LOBECTOMY,ASSISTANT SURGEON",60220,HCPCS,975,RC,80,,,both,704,492.8,,,,,,,,,,,,,,,,,,,Other,119.47,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,103.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,103.89,119.47, LOBE SUB TOTAL LOBE W ISTHMUS,60225,HCPCS,975,RC,,,,both,3375,2362.5,,,,,,,,,,,,,,,,,,,Other,992.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,862.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,862.74,992.15, TOTAL THYROIDECTOMY 90,60240,HCPCS,975,RC,,,,both,3736,2615.2,,,,,,,,,,,,,,,,,,,Other,975.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,848.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,848.56,975.84, "ASST TOTAL THYROIDECTOMY,ASSISTANT SURGEON",60240,HCPCS,975,RC,80,,,both,934,653.8,,,,,,,,,,,,,,,,,,,Other,156.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,135.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,135.77,156.13, THYROIDECTOMY MALIGNANCY LIM DISSEC,60252,HCPCS,975,RC,,,,both,5484,3838.8,,,,,,,,,,,,,,,,,,,Other,1387.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1206.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1206.61,1387.59, THYROID TOTAL POST PREVIOUS RESECTION,60260,HCPCS,975,RC,,,,both,4085,2859.5,,,,,,,,,,,,,,,,,,,Other,1141.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,992.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,992.39,1141.25, "ASST THYROID TOTAL POST PREVIOUS RESECTI,ASSISTANT SURGEON",60260,HCPCS,975,RC,80,,,both,1022,715.4,,,,,,,,,,,,,,,,,,,Other,182.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,158.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,158.78,182.6, THYROIDECTOMY INCLUD SUBST THY GLD,60270,HCPCS,975,RC,,,,both,5212,3648.4,,,,,,,,,,,,,,,,,,,Other,1453.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1263.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1263.68,1453.23, EXC THYROGLOSSAL DUCT/SINUS/FIST,60280,HCPCS,975,RC,,,,both,1911,1337.7,,,,,,,,,,,,,,,,,,,Other,464.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,403.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,403.59,464.13, ASPIRATION AND/OR INJECTION THYROID CYST,60300,HCPCS,975,RC,,,,both,397,277.9,,,,,,,,,,,,,,,,,,,Other,48.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,97.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.76,97.39, PARATHYROIDECTOMY 90G,60500,HCPCS,975,RC,,,,both,3811,2667.7,,,,,,,,,,,,,,,,,,,Other,1050.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,913.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,913.08,1050.04, "ASST PARATHYROIDECTOMY,ASSISTANT SURGEON",60500,HCPCS,975,RC,80,,,both,953,667.1,,,,,,,,,,,,,,,,,,,Other,168,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,146.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,146.09,168, PARATHYROID AUTOTRANSPLANT NO51,60512,HCPCS,975,RC,,,,both,980,686,,,,,,,,,,,,,,,,,,,Other,253.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,220.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,220.57,253.65, "ASST PARATHYROID AUTOTRANSPLANT NO51,ASSISTANT SURGEON",60512,HCPCS,975,RC,80,,,both,245,171.5,,,,,,,,,,,,,,,,,,,Other,40.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,35.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,35.29,40.58, THYMECTOMY,60520,HCPCS,975,RC,,,,both,4538,3176.6,,,,,,,,,,,,,,,,,,,Other,1165.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1013.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1013.76,1165.83, "ASST THYMECTOMY,ASSISTANT SURGEON",60520,HCPCS,975,RC,80,,,both,1135,794.5,,,,,,,,,,,,,,,,,,,Other,186.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,162.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,162.2,186.53, ADRENALECTOMY PARTIAL OR COMPLETE,60540,HCPCS,975,RC,,,,both,4054,2837.8,,,,,,,,,,,,,,,,,,,Other,1195.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1039.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1039.34,1195.24, ADRENALECTOMY PART OR COMPL W/EXCIS,60545,HCPCS,975,RC,,,,both,4853,3397.1,,,,,,,,,,,,,,,,,,,Other,1394.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1212.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1212.71,1394.62, EXCISION CAROTID BODY TUMOR,60600,HCPCS,975,RC,,,,both,4946,3462.2,,,,,,,,,,,,,,,,,,,Other,1476.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1284.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1284.09,1476.71, BURR HOLE(S) WITHEVAC/DRNGE OF HEMATOMA,61154,HCPCS,975,RC,,,,both,5627,3938.9,,,,,,,,,,,,,,,,,,,Other,1549.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1347.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1347.28,1549.38, "ASST BURR HOLE(S) W/EVAC/DRNGE OF HEMATO,ASSISTANT PRACTITIONER",61154,HCPCS,975,RC,AS,,,both,1407,984.9,,,,,,,,,,,,,,,,,,,Other,247.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,215.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,215.56,247.9, NEUROENDOSCOPY INTRACRANIAL FOR PLCMT OF,62160,HCPCS,975,RC,,,,both,831,581.7,,,,,,,,,,,,,,,,,,,Other,216.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,188.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,188.3,216.54, CREATION OF SHUNT; VENTRICULO-PERITONEAL,62223,HCPCS,975,RC,,,,both,5388,3771.6,,,,,,,,,,,,,,,,,,,Other,1221.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1062.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1062.56,1221.95, "CREATION OF SHUNT; VENTRICULO-PERITONEAL,ASSISTANT SURGEON",62223,HCPCS,975,RC,80,,,both,1347,942.9,,,,,,,,,,,,,,,,,,,Other,195.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,170.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,170.01,195.51, SPINAL PUNCTURE LUMBAR DIAGNOSTIC,62270,HCPCS,975,RC,,,,both,551,385.7,,,,,,,,,,,,,,,,,,,Other,71.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,157.19,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,71.48,157.19, SPINAL PUNCTURE FOR DRAINAGE OF CEREBROS,62272,HCPCS,975,RC,,,,both,701,490.7,,,,,,,,,,,,,,,,,,,Other,103.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,208.34,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,103.84,208.34, INJ BLOOD OR CLOT PATCH,62273,HCPCS,975,RC,,,,both,755,528.5,,,,,,,,,,,,,,,,,,,Other,117.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,164.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,117.19,164.36, ASP INTERVERT DISC,62287,HCPCS,975,RC,,,,both,2478,1734.6,,,,,,,,,,,,,,,,,,,Other,601.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,523.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,523.07,601.52, INJECT OF THERAPEUTIC SUBSTNC CERVICAL/T,62321,HCPCS,975,RC,,,,both,956,669.2,,,,,,,,,,,,,,,,,,,Other,108.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,256.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,108.92,256.69, EPIDURAL STEROID INJECTION LUMBAR OR SAC,62323,HCPCS,975,RC,,,,both,950,665,,,,,,,,,,,,,,,,,,,Other,101.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,253.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,101.68,253.08, EPIDURAL STEROID INJ; INTERLAMINAR THORA,62325,HCPCS,975,RC,,,,both,989,692.3,,,,,,,,,,,,,,,,,,,Other,115.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,247.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,115.48,247.45, EPIDURAL STEROID INJ OF LUMBAR/SACRAL W/,62327,HCPCS,975,RC,,,,both,896,627.2,,,,,,,,,,,,,,,,,,,Other,106.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,254.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,106.59,254.97, SPINAL PUNCTURE LUMBAR DIAGNOSTIC W/GUID,62328,HCPCS,975,RC,,,,both,489,342.3,,,,,,,,,,,,,,,,,,,Other,85.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,201.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,85.55,201.4, LAMINECTOMY; 1-2 VERTIBRAL SEGMENT; CERV,63001,HCPCS,975,RC,,,,both,6026,4218.2,,,,,,,,,,,,,,,,,,,Other,1442.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1254.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1254.22,1442.35, "ASST LAMINECTOMY; 1-2 VERTEBRAL SEGMENTS,ASSISTANT SURGEON",63001,HCPCS,975,RC,80,,,both,1565,1095.5,,,,,,,,,,,,,,,,,,,Other,230.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,200.67,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,200.67,230.78, LAMINECTOMY W/EXPLORATION AND/OR DECOMPR,63005,HCPCS,975,RC,,,,both,5519,3863.3,,,,,,,,,,,,,,,,,,,Other,1429.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1242.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1242.73,1429.13, LAMINOTOMYW/DCMPSN NRV ROOT 1 INTERSPACE,63030,HCPCS,975,RC,,,,both,5260,3682,,,,,,,,,,,,,,,,,,,Other,1056.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,918.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,918.63,1056.43, "LAMINOTOMYW/DCMPSN NRV ROOT 1 INTERSPACE,ASSISTANT PRACTITIONER",63030,HCPCS,975,RC,AS,,,both,1315,920.5,,,,,,,,,,,,,,,,,,,Other,169.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,146.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,146.98,169.03, LAMOT PRTL FFD EXC DISC REESPL 1 NTRSPC,63042,HCPCS,975,RC,,,,both,7220,5054,,,,,,,,,,,,,,,,,,,Other,1449.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1260.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1260.51,1449.58, "ASST LAMOT PRTL FFD EXC DISC REESPL 1 NT,ASSISTANT SURGEON",63042,HCPCS,975,RC,80,,,both,1805,1263.5,,,,,,,,,,,,,,,,,,,Other,231.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,201.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,201.68,231.94, "LAMOT PRTL FFD EXC DISC REESPL 1 NTRSPC,ASSISTANT PRACTITIONER",63042,HCPCS,975,RC,AS,,,both,1805,1263.5,,,,,,,,,,,,,,,,,,,Other,231.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,201.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,201.68,231.94, LAMINECTOMY REMOVE SPINE LAMINA 1 CERVIC,63045,HCPCS,975,RC,,,,both,6786,4750.2,,,,,,,,,,,,,,,,,,,Other,1497.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1302.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1302.52,1497.9, "ASST LAMINECTOMY SINGLE VERTEBRAL SEGMEN,ASSISTANT SURGEON",63046,HCPCS,975,RC,80,,,both,1712,1198.4,,,,,,,,,,,,,,,,,,,Other,226.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,196.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,196.76,226.27, "ASST LAMINECTOMY W/SPINAL CORD DECOMPRES,ASSISTANT SURGEON",63047,HCPCS,975,RC,80,,,both,1638,1146.6,,,,,,,,,,,,,,,,,,,Other,202.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,175.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,175.98,202.37, "ASST LAMINECTOMY EACH ADDITIONAL SEGMENT,ASSISTANT SURGEON",63048,HCPCS,975,RC,80,,,both,465,325.5,,,,,,,,,,,,,,,,,,,Other,36.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,32.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,32.1,36.93, "ASST LAMINECTOMY SINGLE VERTEBRAL SEGMEN,ASSISTANT PRACTITIONER",63046,HCPCS,975,RC,AS,,,both,1712,1198.4,,,,,,,,,,,,,,,,,,,Other,226.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,196.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,196.76,226.27, LAMINECTOMY SINGLE VERTEBRAL SEGMENT THO,63046,HCPCS,975,RC,,,,both,6849,4794.3,,,,,,,,,,,,,,,,,,,Other,1414.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1229.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1229.75,1414.22, "ASST LAMINECTOMY W/SPINAL CORD DECOMPRES,ASSISTANT PRACTITIONER",63047,HCPCS,975,RC,AS,,,both,1638,1146.6,,,,,,,,,,,,,,,,,,,Other,202.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,175.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,175.98,202.37, "ASST LAMINECTOMY DURING POSTERIOR INTERB,ASSISTANT PRACTITIONER",63052,HCPCS,975,RC,AS,,,both,445,311.5,,,,,,,,,,,,,,,,,,,Other,45.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,39.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,39.38,45.29, "LAMINECTOMY EACH ADDNL VERTEBRAL SEGMENT,ASSISTANT PRACTITIONER",63053,HCPCS,975,RC,AS,,,both,316,221.2,,,,,,,,,,,,,,,,,,,Other,40.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,35.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,35.11,40.38, LAMINECTOMY W/SPINAL CORD DECOMPRESSION,63047,HCPCS,975,RC,,,,both,6551,4585.7,,,,,,,,,,,,,,,,,,,Other,1264.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1099.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1099.85,1264.84, "ASST LAMINECTOMY EACH ADDITIONAL SEGMENT,ASSISTANT PRACTITIONER",63048,HCPCS,975,RC,AS,,,both,465,325.5,,,,,,,,,,,,,,,,,,,Other,36.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,32.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,32.1,36.93, "TRANSPEDICULAR APPRCH W/DECMPRSN SPINAL,ASSISTANT PRACTITIONER",63056,HCPCS,975,RC,AS,,,both,1899,1329.3,,,,,,,,,,,,,,,,,,,Other,270.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,235.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,235.2,270.48, LAMINECTOMY EACH ADDITIONAL SEGMENT,63048,HCPCS,975,RC,,,,both,1861,1302.7,,,,,,,,,,,,,,,,,,,Other,230.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,200.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,200.68,230.79, LAMINECTOMY DURING POSTERIOR INTERBODY A,63052,HCPCS,975,RC,,,,both,1778,1244.6,,,,,,,,,,,,,,,,,,,Other,283.04,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,246.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,246.13,283.04, LAMINECTOMY EACH ADDNL VERTEBRAL SEGMENT,63053,HCPCS,975,RC,,,,both,1264,884.8,,,,,,,,,,,,,,,,,,,Other,252.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,219.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,219.45,252.37, TRANSPEDICULAR APPROACH W/DECMPRSN OF SP,63056,HCPCS,975,RC,,,,both,7597,5317.9,,,,,,,,,,,,,,,,,,,Other,1690.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1469.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1469.99,1690.49, "ASST VERTEBRAL CORPECTOMY PART/COMPLETE,ASSISTANT SURGEON",63081,HCPCS,975,RC,80,,,both,2176,1523.2,,,,,,,,,,,,,,,,,,,Other,320.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,278.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,278.65,320.45, "ASST VERTEBRAL CORPECTOMY PART/COMPLETE,ASSISTANT PRACTITIONER",63081,HCPCS,975,RC,AS,,,both,2176,1523.2,,,,,,,,,,,,,,,,,,,Other,320.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,278.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,278.65,320.45, VERTEBRAL CORPECTOMY PARTIAL/COMPLETE W/,63081,HCPCS,975,RC,,,,both,8705,6093.5,,,,,,,,,,,,,,,,,,,Other,2002.84,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1741.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1741.6,2002.84, "ASST LAMINECTOMY FOR EXC INTRASPINAL LES,ASSISTANT SURGEON",63267,HCPCS,975,RC,80,,,both,1578,1104.6,,,,,,,,,,,,,,,,,,,Other,253.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,220.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,220.83,253.96, "ASST (PA) LAMINECTOMY FOR EXC INTRASPINA,ASSISTANT PRACTITIONER",63267,HCPCS,975,RC,AS,,,both,1578,1104.6,,,,,,,,,,,,,,,,,,,Other,253.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,220.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,220.83,253.96, LAMINECTOMY FOR EXC OF INTRASPINAL LES E,63267,HCPCS,975,RC,,,,both,6310,4417,,,,,,,,,,,,,,,,,,,Other,1587.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1380.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1380.21,1587.25, IMPLANTATION OF SPINAL CORD STIMULATOR E,63650,HCPCS,975,RC,,,,both,5227,3658.9,,,,,,,,,,,,,,,,,,,Other,428.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2173.74,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,428.46,2173.74, "LAMINECTOMY FOR IMPLANTATION OF NEUROSTI,ASSISTANT PRACTITIONER",63655,HCPCS,975,RC,AS,,,both,1084,758.8,,,,,,,,,,,,,,,,,,,Other,158.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,137.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,137.95,158.65, LAMINECTOMY FOR IMPLANTATION OF NEUROSTI,63655,HCPCS,975,RC,,,,both,4339,3037.3,,,,,,,,,,,,,,,,,,,Other,991.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,862.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,862.23,991.56, REMOVAL OF SPINAL NEUROSTIMULATOR ELECTR,63661,HCPCS,975,RC,,,,both,2428,1699.6,,,,,,,,,,,,,,,,,,,Other,358.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,700.19,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,358.09,700.19, REMOVAL OF SPINAL NEUROSTIMULATOR,63662,HCPCS,975,RC,,,,both,3662,2563.4,,,,,,,,,,,,,,,,,,,Other,1004.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,873.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,873.17,1004.15, "INSERTION OF SPINAL NEUROSTIMULATOR PULS,ASSISTANT PRACTITIONER",63685,HCPCS,975,RC,AS,,,both,551,385.7,,,,,,,,,,,,,,,,,,,Other,59.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,51.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,51.5,59.22, INSERTION OF SPINAL NEUROSTIMULATOR PULS,63685,HCPCS,975,RC,,,,both,2202,1541.4,,,,,,,,,,,,,,,,,,,Other,370.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,321.85,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,321.85,370.13, REMOVE IMPLANTED SPINAL NEUROSTIMULATOR,63688,HCPCS,975,RC,,,,both,1847,1292.9,,,,,,,,,,,,,,,,,,,Other,354.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,308.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,308.07,354.28, INJECTION ANESTHETIC/STEROID; TRIGEMINAL,64400,HCPCS,975,RC,,,,both,504,352.8,,,,,,,,,,,,,,,,,,,Other,56.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,115.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,56.33,115.63, INJJ ANESTHETIC AGENT GREATER OPTICAL NE,64405,HCPCS,975,RC,,,,both,386,270.2,,,,,,,,,,,,,,,,,,,Other,55.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,77.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,55.59,77.62, INJ ANES BRACHIAL PLEXUS NERVE BL,64415,HCPCS,975,RC,,,,both,664,464.8,,,,,,,,,,,,,,,,,,,Other,76.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,145.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,76.11,145.37, SHOULDER NERVE BLOCK SUPRASCAPULAR NERVE,64418,HCPCS,975,RC,,,,both,484,338.8,,,,,,,,,,,,,,,,,,,Other,55.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,85.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,55.68,85.78, BLOCK NERVE INTERCOSTAL,64420,HCPCS,975,RC,,,,both,509,356.3,,,,,,,,,,,,,,,,,,,Other,59.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,99.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,59.59,99.64, INJECTION ANESTHETIC INTERCOSTAL,64421,HCPCS,975,RC,,,,both,665,465.5,,,,,,,,,,,,,,,,,,,Other,25.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,33.84,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,25.17,33.84, NERVE BLOCK ILIOINGUINAL,64425,HCPCS,975,RC,,,,both,550,385,,,,,,,,,,,,,,,,,,,Other,56.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,112.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,56.62,112.89, SCIATIC NERVE BLOCK,64445,HCPCS,975,RC,,,,both,491,343.7,,,,,,,,,,,,,,,,,,,Other,76.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,162.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,76.18,162.17, INJ ANESTHETIC AGENT FEMORAL NERVE (LOMB,64447,HCPCS,975,RC,,,,both,1231,861.7,,,,,,,,,,,,,,,,,,,Other,69.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,126.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,69.78,126.42, ANESTHETIC INJ OTHER PERIPHERAL NRV,64450,HCPCS,975,RC,,,,both,382,267.4,,,,,,,,,,,,,,,,,,,Other,43.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,75.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,43.63,75.89, NERVE BLOCK SACROILIAC JOINT W/IMAGE GUI,64451,HCPCS,975,RC,,,,both,677,473.9,,,,,,,,,,,,,,,,,,,Other,82.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,223.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,82.85,223.26, GENICULAR NERVE BLOCK,64454,HCPCS,975,RC,,,,both,737,515.9,,,,,,,,,,,,,,,,,,,Other,83.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,217.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,83.3,217.07, TRANSFORMINAL EPIDURAL CERVICAL OR THORA,64479,HCPCS,975,RC,,,,both,1093,765.1,,,,,,,,,,,,,,,,,,,Other,132.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,265.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,132.14,265.82, TRANSFORMINAL EPIDURAL CERVICAL OR THORA,64480,HCPCS,975,RC,,,,both,613,429.1,,,,,,,,,,,,,,,,,,,Other,61.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,133.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,61.17,133.58, TRANSFORAMINAL STEROID INJ LUMBAR OR SAC,64483,HCPCS,975,RC,,,,both,1080,756,,,,,,,,,,,,,,,,,,,Other,112.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,245.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,112.63,245.87, TRANSFORAMINAL STEROID INJ LUMBAR OR SAC,64484,HCPCS,975,RC,,,,both,615,430.5,,,,,,,,,,,,,,,,,,,Other,50.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,109.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,50.19,109.69, TAP BLOCK INCLUDES IMAGE GUIDANCE,64486,HCPCS,975,RC,,,,both,555,388.5,,,,,,,,,,,,,,,,,,,Other,55.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,117.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,55.87,117.62, DIAGNOSTIC INJ OF FACET JTS CERVICAL OR,64490,HCPCS,975,RC,,,,both,875,612.5,,,,,,,,,,,,,,,,,,,Other,106.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,192.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,106.87,192.15, DIAGNOSTIC INJ OF FACET JTS CERVICAL OR,64491,HCPCS,975,RC,,,,both,514,359.8,,,,,,,,,,,,,,,,,,,Other,58.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,96.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,58.62,96.71, DIAGNOSTIC INJ OF FACET JTS CERVICAL OR,64492,HCPCS,975,RC,,,,both,507,354.9,,,,,,,,,,,,,,,,,,,Other,58.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,96.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,58.48,96.58, DIAGNOSTIC INJECT OF FACET JTS LUMBAR OR,64493,HCPCS,975,RC,,,,both,840,588,,,,,,,,,,,,,,,,,,,Other,92.13,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,177.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,92.13,177.54, DIAGNOSTIC INJECT OF FACET JTS LUMBAR OR,64494,HCPCS,975,RC,,,,both,506,354.2,,,,,,,,,,,,,,,,,,,Other,50.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,90.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,50.19,90.27, DIAGNOSTIC INJECT OF FACET JTS LUMBAR OR,64495,HCPCS,975,RC,,,,both,462,323.4,,,,,,,,,,,,,,,,,,,Other,51.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,92.95,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,51.56,92.95, STELLATE GANGLION BLOCK (CERVICAL SYMPAT,64510,HCPCS,975,RC,,,,both,735,514.5,,,,,,,,,,,,,,,,,,,Other,78.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,143.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,78.42,143.5, SYMPATHETIC NERVE BLOCK LUMBAR OR THORAC,64520,HCPCS,975,RC,,,,both,866,606.2,,,,,,,,,,,,,,,,,,,Other,86.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,222.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,86.31,222.98, CHEMODENERVATION OF MUSCLE(S); FACIAL/CE,64615,HCPCS,975,RC,,,,both,573,401.1,,,,,,,,,,,,,,,,,,,Other,133.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,158.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,133.45,158.78, KNEE DESTRUCTION GENICULAR NERVE BRANCHE,64624,HCPCS,975,RC,,,,both,1323,926.1,,,,,,,,,,,,,,,,,,,Other,150.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,379.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,150.5,379.51, SACROILIACT JT RADIOFREQUENCY ABLATION W,64625,HCPCS,975,RC,,,,both,1540,1078,,,,,,,,,,,,,,,,,,,Other,200.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,459.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,200.72,459.94, PARAVERTEBRAL FACET JT NERVE DESTRUCTION,64633,HCPCS,975,RC,,,,both,1509,1056.3,,,,,,,,,,,,,,,,,,,Other,195.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,426.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,195.64,426.23, PARAVERTEBRAL FACET JT NERVE DESTRCTN; C,64634,HCPCS,975,RC,,,,both,740,518,,,,,,,,,,,,,,,,,,,Other,66.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,244.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,66.62,244.71, MEDIAL BRANCH DESTRCTN BY NEUROLYTIC AGE,64635,HCPCS,975,RC,,,,both,1542,1079.4,,,,,,,,,,,,,,,,,,,Other,195.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,431.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,195.74,431.4, DESTRUCTION BY NEUROLYTIC AGENT LUMBAR S,64636,HCPCS,975,RC,,,,both,715,500.5,,,,,,,,,,,,,,,,,,,Other,58.62,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,230.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,58.62,230.59, CHEMODENERVATION OF TRUNK MUSCLE; 1-5 MU,64646,HCPCS,975,RC,,,,both,535,374.5,,,,,,,,,,,,,,,,,,,Other,124.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,167.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,124.39,167.64, CHEMODENERVATION OF TRUNK MUSCLE; 6 OR M,64647,HCPCS,975,RC,,,,both,614,429.8,,,,,,,,,,,,,,,,,,,Other,138.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,185.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,138.57,185.96, DESTRUCT CELIAC PLEXUS LYTIC NA,64680,HCPCS,975,RC,,,,both,1194,835.8,,,,,,,,,,,,,,,,,,,Other,165.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,323.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,165.75,323.15, NEUROPLASTY BRACHIAL PLEXUS,64713,HCPCS,975,RC,,,,both,3636,2545.2,,,,,,,,,,,,,,,,,,,Other,866.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,753.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,753.3,866.29, CUBITAL TUNNEL NEUROPLASTY 90G,64718,HCPCS,975,RC,,,,both,2574,1801.8,,,,,,,,,,,,,,,,,,,Other,649.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,565.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,565.21,649.98, "ASST CUBITAL TUNNEL NEUROPLASTY 90G,ASSISTANT SURGEON",64718,HCPCS,975,RC,80,,,both,644,450.8,,,,,,,,,,,,,,,,,,,Other,104,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,90.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,90.43,104, "ASST (PA) CUBITAL TUNNEL NEUROPLASTY 90G,ASSISTANT PRACTITIONER",64718,HCPCS,975,RC,AS,,,both,644,450.8,,,,,,,,,,,,,,,,,,,Other,104,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,90.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,90.43,104, DECOMPRESSION OF ULNAR NERVE AT WRIST,64719,HCPCS,975,RC,,,,both,1728,1209.6,,,,,,,,,,,,,,,,,,,Other,438.38,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,381.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,381.2,438.38, CARPAL TUNNEL NEUROPLASTY 90G,64721,HCPCS,975,RC,,,,both,1902,1331.4,,,,,,,,,,,,,,,,,,,Other,475.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,466.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,466.72,475.54, NEUROLYSIS INTERNAL (+),64727,HCPCS,975,RC,,,,both,1084,758.8,,,,,,,,,,,,,,,,,,,Other,165.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,143.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,143.83,165.41, NERVE EXC NEUROMA DIGIT,64776,HCPCS,975,RC,,,,both,1437,1005.9,,,,,,,,,,,,,,,,,,,Other,425.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,369.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,369.92,425.41, EXC OF MAJOR PERIPHERAL NERVE,64784,HCPCS,975,RC,,,,both,2852,1996.4,,,,,,,,,,,,,,,,,,,Other,777.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,675.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,675.92,777.31, NERVE BIOPSY,64795,HCPCS,975,RC,,,,both,845,591.5,,,,,,,,,,,,,,,,,,,Other,222.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,193.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,193.82,222.9, DORSAL SYMPATHECTOMY,64804,HCPCS,975,RC,,,,both,4556,3189.2,,,,,,,,,,,,,,,,,,,Other,1445.56,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,1257.01,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1257.01,1445.56, LUMBAR SYMPATHECTOMY 90,64818,HCPCS,975,RC,,,,both,2808,1965.6,,,,,,,,,,,,,,,,,,,Other,833.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,725.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,725.13,833.9, REMOVAL FOREIGN BODY EYE,65205,HCPCS,975,RC,,,,both,171,119.7,,,,,,,,,,,,,,,,,,,Other,27.15,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.89,27.15, REMOVAL OF FB CONJUNCT EMBEDDED,65210,HCPCS,975,RC,,,,both,215,150.5,,,,,,,,,,,,,,,,,,,Other,33.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,33.59,36.39, FB REMOVAL FOREIGN BODY CORNEA,65220,HCPCS,975,RC,,,,both,276,193.2,,,,,,,,,,,,,,,,,,,Other,43.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,61.26,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,43.3,61.26, EYE LESION EXCISION 90G,65400,HCPCS,975,RC,,,,both,1855,1298.5,,,,,,,,,,,,,,,,,,,Other,577.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,658.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,577.17,658.48, REMOVAL CORNEAL EPITHELIUM ABR/CURR,65435,HCPCS,975,RC,,,,both,220,154,,,,,,,,,,,,,,,,,,,Other,66.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,78.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,66.87,78.76, EYELID EXC LESION,67800,HCPCS,975,RC,,,,both,338,236.6,,,,,,,,,,,,,,,,,,,Other,96.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,123.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,96.54,123.09, EYELID BIOPSY,67810,HCPCS,975,RC,,,,both,476,333.2,,,,,,,,,,,,,,,,,,,Other,63.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,167.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,63.17,167.59, EXC EYELID LESION 10G,67840,HCPCS,975,RC,,,,both,700,490,,,,,,,,,,,,,,,,,,,Other,149,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,258.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,149,258.07, SUTURE EYELID WOUND,67930,HCPCS,975,RC,,,,both,979,685.3,,,,,,,,,,,,,,,,,,,Other,222.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,351.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,222.17,351.58, I/D ABSCESS HEMATOMA EXT EAR,69000,HCPCS,975,RC,,,,both,518,362.6,,,,,,,,,,,,,,,,,,,Other,131.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,180.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,131.39,180.59, DRAINAGE/EXT EAR ABCESS/HEMATOMA COMPLIC,69005,HCPCS,975,RC,,,,both,721,504.7,,,,,,,,,,,,,,,,,,,Other,165.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,212.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,165.51,212.06, BIOPSY EXTERNAL EAR,69100,HCPCS,975,RC,,,,both,237,165.9,,,,,,,,,,,,,,,,,,,Other,42.8,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,86.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,42.8,86.52, EAR EXCISION PARTIAL SIMPLE REPAIR 90G,69110,HCPCS,975,RC,,,,both,1246,872.2,,,,,,,,,,,,,,,,,,,Other,332.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,440.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,332.82,440.32, REMOVAL FOREIGN BODY AUDITORY CANAL,69200,HCPCS,975,RC,,,,both,316,221.2,,,,,,,,,,,,,,,,,,,Other,48.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,77.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.11,77.69, EAR LAVAGE,69209,HCPCS,960,RC,,,,both,54,37.8,,,,,,,,,,,,,,,,,,,Other,17.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.45,17.78, EAR LAVAGE W/ INSTRUMENT,69210,HCPCS,975,RC,,,,both,147,102.9,,,,,,,,,,,,,,,,,,,Other,31.49,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,45.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.49,45.9, OPERATING MICROSCOPE,69990,HCPCS,975,RC,,,,both,1283,898.1,,,,,,,,,,,,,,,,,,,Other,248.85,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,216.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,216.39,248.85, MYELOGRAPHY LUMBOSACRAL RADIOLOGICAL SPR,72265,HCPCS,960,RC,,,,both,209,146.3,,,,,,,,,,,,,,,,,,,Other,45.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,102.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,45.11,102.2, "CORONARY CALCIUM SCORING,TECHNICAL COMPONENT",75571,HCPCS,960,RC,26,,,both,50,35,,,,,,,,,,,,,,,,,,,Other,30.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.17,30.1, "THORACIC AORTOGRAPHY ANGIO,TECHNICAL COMPONENT",75605,HCPCS,975,RC,26,,,both,227,158.9,,,,,,,,,,,,,,,,,,,Other,60.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,52.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,52.33,60.18, "ABDOMINAL AORTOGRAPHY ANGIO,TECHNICAL COMPONENT",75625,HCPCS,975,RC,26,,,both,301,210.7,,,,,,,,,,,,,,,,,,,Other,77.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,67.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,67.33,77.43, "ABDM AORTA ANGIO W/RUN-OFF,TECHNICAL COMPONENT",75630,HCPCS,921,RC,26,,,both,389,272.3,,,,,,,,,,,,,,,,,,,Other,83.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,91.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,83.87,91.61, "CTA ABDOM AORTA BILAT IL-FEM RUNOFF,TECHNICAL COMPONENT",75635,HCPCS,921,RC,26,,,both,538,376.6,,,,,,,,,,,,,,,,,,,Other,115.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,107.88,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,107.88,115.99, "UNILATERAL EXTREMITY ANGIO,TECHNICAL COMPONENT",75710,HCPCS,921,RC,26,,,both,372,260.4,,,,,,,,,,,,,,,,,,,Other,80.2,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,81.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,80.2,81.79, "EXTEM BILAT ANGIOGRAPHY,TECHNICAL COMPONENT",75716,HCPCS,921,RC,26,,,both,407,284.9,,,,,,,,,,,,,,,,,,,Other,87.75,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,90.63,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,87.75,90.63, "SELECTIVE VISCERAL ANGIO,TECHNICAL COMPONENT",75726,HCPCS,921,RC,26,,,both,379,265.3,,,,,,,,,,,,,,,,,,,Other,81.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,90.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,81.71,90.39, "SELECTIVE PELVIC ANGIO,TECHNICAL COMPONENT",75736,HCPCS,921,RC,26,,,both,238,166.6,,,,,,,,,,,,,,,,,,,Other,51.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,49.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,49.69,51.31, "UNILATERAL PULMONARY ANGIO,TECHNICAL COMPONENT",75741,HCPCS,921,RC,26,,,both,321,224.7,,,,,,,,,,,,,,,,,,,Other,69.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,57.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,57.86,69.21, "BILATERAL PULMONARY ANGIO,TECHNICAL COMPONENT",75743,HCPCS,921,RC,26,,,both,392,274.4,,,,,,,,,,,,,,,,,,,Other,84.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,73.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,73.81,84.52, "ANGIO PULMONARY,TECHNICAL COMPONENT",75746,HCPCS,921,RC,26,,,both,272,190.4,,,,,,,,,,,,,,,,,,,Other,58.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,50.37,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,50.37,58.64, "ANGIO SELECTIVE ADDITIONAL,TECHNICAL COMPONENT",75774,HCPCS,921,RC,26,,,both,191,133.7,,,,,,,,,,,,,,,,,,,Other,41.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,44.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,41.18,44.03, "UNILATERAL EXTREMITY VENOGRAPHY,TECHNICAL COMPONENT",75820,HCPCS,921,RC,26,,,both,176,123.2,,,,,,,,,,,,,,,,,,,Other,37.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,47.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,37.95,47.64, "BILATERAL EXTREMITY VENOGRAPHY,TECHNICAL COMPONENT",75822,HCPCS,921,RC,26,,,both,238,166.6,,,,,,,,,,,,,,,,,,,Other,51.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,67.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,51.31,67.24, "INFERIOR VENACAVOGRAPHY,TECHNICAL COMPONENT",75825,HCPCS,921,RC,26,,,both,263,184.1,,,,,,,,,,,,,,,,,,,Other,56.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,52.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,52.55,56.7, "SUPERIOR VENACAVOGRAPHY,TECHNICAL COMPONENT",75827,HCPCS,921,RC,26,,,both,251,175.7,,,,,,,,,,,,,,,,,,,Other,54.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,53.36,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,53.36,54.12, "BILATERAL RENAL VENOGRAPHY,TECHNICAL COMPONENT",75831,HCPCS,921,RC,26,,,both,256,179.2,,,,,,,,,,,,,,,,,,,Other,55.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,49.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,49.9,55.19, "VENOGRAPHY RENAL SELECTIVE,TECHNICAL COMPONENT",75833,HCPCS,921,RC,26,,,both,293,205.1,,,,,,,,,,,,,,,,,,,Other,63.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,72.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,63.17,72.64, "HEPATIC VENOGRAM,TECHNICAL COMPONENT",75889,HCPCS,921,RC,26,,,both,125,87.5,,,,,,,,,,,,,,,,,,,Other,26.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,49.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.95,49.48, "HEPATIC VENOGRAPHY W/O HEMODYN EVAL,TECHNICAL COMPONENT",75891,HCPCS,921,RC,26,,,both,250,175,,,,,,,,,,,,,,,,,,,Other,53.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,49.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,49.77,53.9, HEPATIC VENOGRAPHY W/O HEMODYN EVAL,75891,HCPCS,960,RC,,,,both,250,175,,,,,,,,,,,,,,,,,,,Other,57.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,115.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,57.24,115.05, "VENOUS SAMPLING THROUGH CATHETER,TECHNICAL COMPONENT",75893,HCPCS,921,RC,26,,,both,66,46.2,,,,,,,,,,,,,,,,,,,Other,14.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.23,26.1, "TRANSCATHETER EMBOLIZATION ANGIO,TECHNICAL COMPONENT",75894,HCPCS,921,RC,26,,,both,284,198.8,,,,,,,,,,,,,,,,,,,Other,61.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,130.61,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,61.23,130.61, "ANGIO THRU EXISTING CATHETER,TECHNICAL COMPONENT",75898,HCPCS,921,RC,26,,,both,303,212.1,,,,,,,,,,,,,,,,,,,Other,65.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,108.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.33,108.89, "CHNG PERC TUBE/CATH W/CONTRAST,TECHNICAL COMPONENT",75984,HCPCS,921,RC,26,,,both,172,120.4,,,,,,,,,,,,,,,,,,,Other,37.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.76,37.08, "PERC DRAIN ABSCESS RADIOL GUIDANCE,TECHNICAL COMPONENT",75989,HCPCS,921,RC,26,,,both,272,190.4,,,,,,,,,,,,,,,,,,,Other,58.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,53.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,53.71,58.64, "FLOUROSCOPY <=60 MIN PHYS,TECHNICAL COMPONENT",76000,HCPCS,960,RC,26,,,both,81,56.7,,,,,,,,,,,,,,,,,,,Other,17.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.24,17.52, "RAD EXAM ABSCESS FISTULA S/I,TECHNICAL COMPONENT",76080,HCPCS,960,RC,26,,,both,108,75.6,,,,,,,,,,,,,,,,,,,Other,27.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.87,27.45, "RAD EXAM POST-OP SPECIMEN,TECHNICAL COMPONENT",76098,HCPCS,960,RC,26,,,both,40,28,,,,,,,,,,,,,,,,,,,Other,16.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.43,16.59, ULTRASOUND SOFT TISSUE OF NECK LIMITED (,76536,HCPCS,960,RC,,,,both,361,252.7,,,,,,,,,,,,,,,,,,,Other,29.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,99.55,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,29.68,99.55, US BREAST UNILATERAL LIMITED,76642,HCPCS,960,RC,,,,both,320,224,,,,,,,,,,,,,,,,,,,Other,35.45,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,77.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,35.45,77.66, ABDOMINAL ULTRA SOUND LIMITED (OFFICE),76706,HCPCS,960,RC,,,,both,342,239.4,,,,,,,,,,,,,,,,,,,Other,29.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,97.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,29.21,97.33, ULTASOUND RETROPERITONEAL (RENAL/AORTIC),76775,HCPCS,960,RC,,,,both,298,208.6,,,,,,,,,,,,,,,,,,,Other,30.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,56.87,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.44,56.87, "US SCROTAL/TESTICULAR,TECHNICAL COMPONENT",76870,HCPCS,960,RC,26,,,both,117,81.9,,,,,,,,,,,,,,,,,,,Other,33.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,29.21,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,29.21,33.59, ULTRASOUND SCROTUM AND CONTENTS,76870,HCPCS,960,RC,,,,both,390,273,,,,,,,,,,,,,,,,,,,Other,33.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,90.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,33.59,90.99, ULTRASOUND NON-VASCULAR OF EXTREMITY LIM,76882,HCPCS,960,RC,,,,both,174,121.8,,,,,,,,,,,,,,,,,,,Other,36.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,60.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.16,60.35, "US S/I VASCULAR ACCESS SITE,TECHNICAL COMPONENT",76937,HCPCS,960,RC,26,,,both,47,32.9,,,,,,,,,,,,,,,,,,,Other,15.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.72,15.78, "US GUIDED NEEDLE/BX ASP INJ LOCAL,TECHNICAL COMPONENT",76942,HCPCS,960,RC,26,,,both,164,114.8,,,,,,,,,,,,,,,,,,,Other,35.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,30.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,30.59,35.17, US GUIDANCE FOR NEEDLE PLACEMENT - OFFIC,76942,HCPCS,960,RC,,,,both,449,314.3,,,,,,,,,,,,,,,,,,,Other,35.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,60.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,35.17,60.08, "US GUIDANCE INTRAOPERATIVE,TECHNICAL COMPONENT",76998,HCPCS,960,RC,26,,,both,115,80.5,,,,,,,,,,,,,,,,,,,Other,57.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,49.57,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,49.57,57.01, "FLOURO FOR CVC PLACEMENT,TECHNICAL COMPONENT",77001,HCPCS,960,RC,26,,,both,60,42,,,,,,,,,,,,,,,,,,,Other,20.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.75,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.75,20.41, "FLOUROSCOPY GUIDANCE NEEDLE BX/ASP,TECHNICAL COMPONENT",77002,HCPCS,960,RC,26,,,both,74,51.8,,,,,,,,,,,,,,,,,,,Other,30.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,26.35,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.35,30.3, "FLOURO SPINE NEEDLE PLACEMENT,TECHNICAL COMPONENT",77003,HCPCS,960,RC,26,,,both,87,60.9,,,,,,,,,,,,,,,,,,,Other,32.12,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,27.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.93,32.12, "STEREOTACTIC BX BRST,TECHNICAL COMPONENT",77011,HCPCS,960,RC,26,,,both,328,229.6,,,,,,,,,,,,,,,,,,,Other,67.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,58.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,58.64,67.44, "CT GUIDE NEEDLE BX-ASP-INJ-LOC S/I,TECHNICAL COMPONENT",77012,HCPCS,960,RC,26,,,both,389,272.3,,,,,,,,,,,,,,,,,,,Other,76.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,66.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,66.14,76.06, "MAMMOGRAM DIAGNOSTIC; UNILATERAL (PROFES,TECHNICAL COMPONENT",77065,HCPCS,960,RC,26,,,both,150,105,,,,,,,,,,,,,,,,,,,Other,42.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,37.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,37.08,42.65, "CT OF BONE MINERAL DENSITY,TECHNICAL COMPONENT",77078,HCPCS,960,RC,26,,,both,45,31.5,,,,,,,,,,,,,,,,,,,Other,12.71,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.05,12.71, "DEXA SCAN INTERPRETATION (BONE DENSITY S,TECHNICAL COMPONENT",77080,HCPCS,960,RC,26,,,both,82,57.4,,,,,,,,,,,,,,,,,,,Other,10.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.15,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.15,10.53, DIP UA URINALYSIS DIPSTICK,81000,HCPCS,301,RC,,,,both,5,3.5,,,,,,,,,,,,,,,,,,,Other,1.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,1.08,3.94, URINE DIPSTICK MC,81002,HCPCS,301,RC,,,,both,15,10.5,,,,,,,,,,,,,,,,,,,Other,3.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,3.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,3.23,3.41, "PREGNANCY URINE HCG,CLIA WAIVED",81025,HCPCS,301,RC,QW,,,both,35,24.5,,,,,,,,,,,,,,,,,,,Other,7.55,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.55,8.44, "IFOB - BLOOD OCCULT - COMMERCIAL INSURAN,CLIA WAIVED",82274,HCPCS,301,RC,QW,,,both,24,16.8,,,,,,,,,,,,,,,,,,,Other,5.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.17,15.6, "HEMACUE HEMOGLOBIN FINGERSTICK,CLIA WAIVED",85018,HCPCS,300,RC,QW,,,both,21,14.7,,,,,,,,,,,,,,,,,,,Other,4.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,2.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,2.32,4.53, "RAPID FLU OSOM ULTRAFLU A AND B,CLIA WAIVED",87804,HCPCS,300,RC,QW,,,both,52,36.4,,,,,,,,,,,,,,,,,,,Other,11.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.22,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.21,16.22, "QUIDEL QUICKVUE IN LINE STREP A,CLIA WAIVED",87880,HCPCS,300,RC,QW,,,both,52,36.4,,,,,,,,,,,,,,,,,,,Other,11.21,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.21,16.2, ADMIN SINGLE IMMUNIZATION,90471,HCPCS,771,RC,,,,both,45,31.5,,,,,,,,,,,,,,,,,,,Other,9.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.7,20.42, ADMIN ADDITIONAL VACCINE EACH,90472,HCPCS,771,RC,,,,both,29,20.3,,,,,,,,,,,,,,,,,,,Other,6.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.98,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.25,14.98, "ESOPH MANOMETRY,TECHNICAL COMPONENT",91010,HCPCS,960,RC,26,,,both,204,142.8,,,,,,,,,,,,,,,,,,,Other,75.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,65.72,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.72,75.58, "RESTECH PH PROBE/RECORDING/INTERP,TECHNICAL COMPONENT",91034,HCPCS,960,RC,26,,,both,146,102.2,,,,,,,,,,,,,,,,,,,Other,56.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,49.11,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,49.11,56.48, "REFLUX TEST WITH PH REC/ANALY/INTER (BRA,TECHNICAL COMPONENT",91035,HCPCS,975,RC,26,,,both,266,186.2,,,,,,,,,,,,,,,,,,,Other,95.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,83.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,83.39,95.89, REFLUX TEST WITH PH REC/ANALY/INTER,91035,HCPCS,960,RC,,,,both,1474,1031.8,,,,,,,,,,,,,,,,,,,Other,95.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,457.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,95.89,457.08, "PILLCAM INTERP,TECHNICAL COMPONENT",91110,HCPCS,975,RC,26,,,both,412,288.4,,,,,,,,,,,,,,,,,,,Other,130.42,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,113.41,130.42, NASOPHARYNGOSCOPY WITH ENDOSCOPE,92511,HCPCS,975,RC,,,,both,393,275.1,,,,,,,,,,,,,,,,,,,Other,36.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,106.23,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,36.59,106.23, CPR,92950,HCPCS,960,RC,,,,both,1425,997.5,,,,,,,,,,,,,,,,,,,Other,198.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,359.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,198.81,359.66, CARDIOVERSION EXTERNAL,92960,HCPCS,975,RC,,,,both,677,473.9,,,,,,,,,,,,,,,,,,,Other,107.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,147.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,107.66,147.12, EKG TOTAL SERVICE,93000,HCPCS,960,RC,,,,both,78,54.6,,,,,,,,,,,,,,,,,,,Other,16.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.66,16.86, RHYTHM STRIP,93005,HCPCS,730,RC,,,,both,54,37.8,,,,,,,,,,,,,,,,,,,Other,11.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.49,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.49,11.64, EKG INTERPRETATION,93010,HCPCS,960,RC,,,,both,56,39.2,,,,,,,,,,,,,,,,,,,Other,9.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.16,9.39, EKG STRESS TEST TREADMILL DON'T USE (IN,93015,HCPCS,960,RC,,,,both,346,242.2,,,,,,,,,,,,,,,,,,,Other,78.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,68.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,68.68,78.98, STRESS TEST SUPERVISION,93016,HCPCS,960,RC,,,,both,97,67.9,,,,,,,,,,,,,,,,,,,Other,22.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,19.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.99,22.99, STRESS TEST INTERPRETAION REPORT,93018,HCPCS,960,RC,,,,both,100,70,,,,,,,,,,,,,,,,,,,Other,15.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.29,15.28, RHYTHEM STRIP INTERP & REPORT,93042,HCPCS,960,RC,,,,both,62,43.4,,,,,,,,,,,,,,,,,,,Other,7.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,6.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.92,7.96, HOLTER MONITOR INTERP,93227,HCPCS,960,RC,,,,both,125,87.5,,,,,,,,,,,,,,,,,,,Other,19.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,17.13,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.13,19.7, EVENT MONITOR TELEMETRY (REALTIME) 30 DA,93228,HCPCS,960,RC,,,,both,93,65.1,,,,,,,,,,,,,,,,,,,Other,28.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.39,28.05, HOLTER MONITOR INTERPRATATION 3 - 7 DAYS,93244,HCPCS,960,RC,,,,both,89,62.3,,,,,,,,,,,,,,,,,,,Other,25.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,22.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,22.14,25.46, HOLTER MONITOR INTERPRATATION 8 - 15 DAY,93248,HCPCS,960,RC,,,,both,101,70.7,,,,,,,,,,,,,,,,,,,Other,27.69,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.08,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.08,27.69, EVENT MONITOR-KING OF HEARTS 30 DAY,93272,HCPCS,960,RC,,,,both,107,74.9,,,,,,,,,,,,,,,,,,,Other,26.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.1,26.57, ECHO 2D,93307,HCPCS,960,RC,,,,both,550,385,,,,,,,,,,,,,,,,,,,Other,48.02,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,127.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,48.02,127.06, TEE TRANSESOPHAGEAL ECHO PROBE PLAC,93313,HCPCS,960,RC,,,,both,475,332.5,,,,,,,,,,,,,,,,,,,Other,11.96,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.4,11.96, TEE PROBE PLACEMENT CONGENITAL ANOM,93316,HCPCS,960,RC,,,,both,325,227.5,,,,,,,,,,,,,,,,,,,Other,28.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,24.56,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.56,28.24, ECHO DOPPLER,93320,HCPCS,960,RC,,,,both,259,181.3,,,,,,,,,,,,,,,,,,,Other,19.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,47.5,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,19.33,47.5, "DOBUTAMINE STRESS ECHO,TECHNICAL COMPONENT",93350,HCPCS,960,RC,26,,,both,277,193.9,,,,,,,,,,,,,,,,,,,Other,75.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,65.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.47,75.29, "ECHO STRESS TEST W/PHYS SUPERVISION INTE,TECHNICAL COMPONENT",93351,HCPCS,960,RC,26,,,both,336,235.2,,,,,,,,,,,,,,,,,,,Other,90.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,78.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,78.76,90.58, ECHO STRESS TEST,93350,HCPCS,960,RC,,,,both,750,525,,,,,,,,,,,,,,,,,,,Other,75.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,171.39,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,75.29,171.39, "RIGHT HEART CATH INC CO/O2 SATURATION,TECHNICAL COMPONENT",93451,HCPCS,921,RC,26,,,both,357,249.9,,,,,,,,,,,,,,,,,,,Other,76.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,129.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,76.97,129.62, "CATH PLCMNT IN CORONARY ARTERY FOR ANGIO,TECHNICAL COMPONENT",93454,HCPCS,921,RC,26,,,both,598,418.6,,,,,,,,,,,,,,,,,,,Other,128.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,239.73,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,128.93,239.73, SWAN-GANZ CATHETER 00G,93503,HCPCS,921,RC,,,,both,1542,1079.4,,,,,,,,,,,,,,,,,,,Other,332.46,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,82.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,82.3,332.46, "VENOUS PRESSURE MONITORING,TECHNICAL COMPONENT",93770,HCPCS,921,RC,26,,,both,45,31.5,,,,,,,,,,,,,,,,,,,Other,9.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,9.7,9.7, BP MONITOR 24 HR RECORD SCAN INTERP,93784,HCPCS,960,RC,,,,both,234,163.8,,,,,,,,,,,,,,,,,,,Other,51.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,44.42,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,44.42,51.09, "DUPLEX CEREBRAL BILATERAL (CAROTID DUPLE,TECHNICAL COMPONENT",93880,HCPCS,921,RC,26,,,both,125,87.5,,,,,,,,,,,,,,,,,,,Other,26.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,37.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.95,37.18, "DUPLEX CEREBRAL UNILATERAL/LIMITED,TECHNICAL COMPONENT",93882,HCPCS,921,RC,26,,,both,77,53.9,,,,,,,,,,,,,,,,,,,Other,16.6,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.6,23.59, CAROTID DUPLEX UNILATERAL,93882,HCPCS,921,RC,,,,both,384,268.8,,,,,,,,,,,,,,,,,,,Other,82.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,82.79,113.97, TRANSCRANIAL DUPLEX,93886,HCPCS,921,RC,,,,both,669,468.3,,,,,,,,,,,,,,,,,,,Other,144.24,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,245.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,144.24,245.89, "DOPPLER ABI TBI PBI U/L SINGLE LEV,TECHNICAL COMPONENT",93922,HCPCS,921,RC,26,,,both,46,32.2,,,,,,,,,,,,,,,,,,,Other,9.92,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.92,11.78, "TCO2 HYPEREMIA SEG PBI UP/LOW MULT,TECHNICAL COMPONENT",93923,HCPCS,921,RC,26,,,both,76,53.2,,,,,,,,,,,,,,,,,,,Other,16.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,21.66,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.39,21.66, "DOPPLER ABI W/EXERCISE PBI BILAT,TECHNICAL COMPONENT",93924,HCPCS,921,RC,26,,,both,83,58.1,,,,,,,,,,,,,,,,,,,Other,17.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.89,23.89, "DUPLEX LOWER EXT BILATERAL,TECHNICAL COMPONENT",93925,HCPCS,921,RC,26,,,both,113,79.1,,,,,,,,,,,,,,,,,,,Other,24.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,24.36,36.58, "DUPLEX LOWER EXT UNILAT/LIMITD,TECHNICAL COMPONENT",93926,HCPCS,921,RC,26,,,both,78,54.6,,,,,,,,,,,,,,,,,,,Other,16.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,22.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,16.82,22.48, DOPPLER ABI TBI PBI,93922,HCPCS,921,RC,,,,both,304,212.8,,,,,,,,,,,,,,,,,,,Other,65.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,76.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.54,76.17, TCO2 TRANSCU OXIMTERY HYPEREMIA 26,93923,HCPCS,921,RC,,,,both,446,312.2,,,,,,,,,,,,,,,,,,,Other,96.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,122.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,96.16,122.71, EXERCISE ABI LOWER ART BILATERAL,93924,HCPCS,921,RC,,,,both,555,388.5,,,,,,,,,,,,,,,,,,,Other,119.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,151.24,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,119.66,151.24, "DUPLEX UPPER EXTREMITY BILATERAL,TECHNICAL COMPONENT",93930,HCPCS,921,RC,26,,,both,119,83.3,,,,,,,,,,,,,,,,,,,Other,25.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,25.66,36.89, "DUPLEX UPPER EXTREMITY UNILAT/LIMTD,TECHNICAL COMPONENT",93931,HCPCS,921,RC,26,,,both,84,58.8,,,,,,,,,,,,,,,,,,,Other,18.11,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,22.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.11,22.78, BYPASS GRAFT SURVEILLANCE BILATERAL,93925,HCPCS,921,RC,,,,both,711,497.7,,,,,,,,,,,,,,,,,,,Other,153.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,217.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,153.29,217.04, DUPLEX ART/GRFT UNILATERAL LIMITED,93926,HCPCS,921,RC,,,,both,489,342.3,,,,,,,,,,,,,,,,,,,Other,105.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,128.31,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,105.43,128.31, UPPER EXT DUPLEX ART/BILATERAL,93930,HCPCS,921,RC,,,,both,598,418.6,,,,,,,,,,,,,,,,,,,Other,128.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,182.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,128.93,182.16, UPPER EXT DUPLEX ART/UNILATERAL,93931,HCPCS,921,RC,,,,both,440,308,,,,,,,,,,,,,,,,,,,Other,94.86,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,111.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,94.86,111.07, "DUPLEX DEEP VEIN BILATERAL,TECHNICAL COMPONENT",93970,HCPCS,921,RC,26,,,both,111,77.7,,,,,,,,,,,,,,,,,,,Other,23.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,31.9,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.93,31.9, "DUPLEX DEEP VEIN UNILATERAL,TECHNICAL COMPONENT",93971,HCPCS,921,RC,26,,,both,83,58.1,,,,,,,,,,,,,,,,,,,Other,17.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,17.89,20.12, DEEP VEIN DUPLEX LIMITED (OFFICE),93971,HCPCS,921,RC,,,,both,460,322,,,,,,,,,,,,,,,,,,,Other,99.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,106.32,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,99.18,106.32, "DUPLEX RENAL MESENTERIC COMPLETE,TECHNICAL COMPONENT",93975,HCPCS,921,RC,26,,,both,174,121.8,,,,,,,,,,,,,,,,,,,Other,37.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,52.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,37.51,52.65, "DUPLEX RENAL MESENTERIC LIMITED,TECHNICAL COMPONENT",93976,HCPCS,921,RC,26,,,both,144,100.8,,,,,,,,,,,,,,,,,,,Other,31.05,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,36.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.05,36.46, DUPLEX RENAL MESENTERIC UNILAT LIM,93976,HCPCS,921,RC,,,,both,599,419.3,,,,,,,,,,,,,,,,,,,Other,129.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,143.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,129.14,143.28, "DUPLEX AORTA IVC ILIAC BPG COMPLETE,TECHNICAL COMPONENT",93978,HCPCS,921,RC,26,,,both,121,84.7,,,,,,,,,,,,,,,,,,,Other,26.09,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,38.03,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,26.09,38.03, "DUPLEX AORTA IVC ILIAC BPG UNIL/LIM,TECHNICAL COMPONENT",93979,HCPCS,921,RC,26,,,both,87,60.9,,,,,,,,,,,,,,,,,,,Other,18.76,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.29,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.76,23.29, "DUPLEX PENILE COMPLETE,TECHNICAL COMPONENT",93980,HCPCS,921,RC,26,,,both,320,224,,,,,,,,,,,,,,,,,,,Other,68.99,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,58.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,58.04,68.99, "DUPLEX PENILE F/U OR LIMITED,TECHNICAL COMPONENT",93981,HCPCS,921,RC,26,,,both,110,77,,,,,,,,,,,,,,,,,,,Other,23.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,20.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,20.69,23.72, AORTA/ILIAC/AAA SCREEN,93978,HCPCS,921,RC,,,,both,575,402.5,,,,,,,,,,,,,,,,,,,Other,123.97,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,166.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,123.97,166.58, VISCERAL/PENILE VASC STUD UNILA LMT,93979,HCPCS,921,RC,,,,both,435,304.5,,,,,,,,,,,,,,,,,,,Other,93.79,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,107.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,93.79,107.4, DUPLEX SCAN OF PENILE VESS;COMPLETE,93980,HCPCS,921,RC,,,,both,616,431.2,,,,,,,,,,,,,,,,,,,Other,132.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,112.94,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,112.94,132.81, DUPLEX PENILE FOLLOW-UP OR LIMITED,93981,HCPCS,921,RC,,,,both,358,250.6,,,,,,,,,,,,,,,,,,,Other,77.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,67.83,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,67.83,77.18, "DUPLEX HEMODIALYSIS ACCESS,TECHNICAL COMPONENT",93990,HCPCS,921,RC,26,,,both,86,60.2,,,,,,,,,,,,,,,,,,,Other,18.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,22.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,18.54,22.91, DUPLEX-HEMODIALYSIS ACCESS,93990,HCPCS,921,RC,,,,both,535,374.5,,,,,,,,,,,,,,,,,,,Other,115.35,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,132.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,115.35,132.62, "PFT SPIROMETRY PRE,TECHNICAL COMPONENT",94010,HCPCS,960,RC,26,,,both,31,21.7,,,,,,,,,,,,,,,,,,,Other,9.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,8.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.16,9.39, "SPIROMETRY PRE AND POST,TECHNICAL COMPONENT",94060,HCPCS,960,RC,26,,,both,45,31.5,,,,,,,,,,,,,,,,,,,Other,11.58,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,10.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,10.07,11.58, "BRONCHIAL PROVOCATION,TECHNICAL COMPONENT",94070,HCPCS,960,RC,26,,,both,105,73.5,,,,,,,,,,,,,,,,,,,Other,32.22,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,28.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,28.02,32.22, "RESPIRATORY FLOW VOLUME LOOP,TECHNICAL COMPONENT",94375,HCPCS,960,RC,26,,,both,41,28.7,,,,,,,,,,,,,,,,,,,Other,16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,13.92,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.92,16, NEBULIZER TREATMENT,94640,HCPCS,410,RC,,,,both,57,39.9,,,,,,,,,,,,,,,,,,,Other,12.29,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,7.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.99,12.29, "LUNG VOLUMES AND AIRWAY RESISTANCE,TECHNICAL COMPONENT",94726,HCPCS,960,RC,26,,,both,37,25.9,,,,,,,,,,,,,,,,,,,Other,13.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.68,13.44, "GAS DILUTION WASHOUT FOR LUNG VOLUM,TECHNICAL COMPONENT",94727,HCPCS,960,RC,26,,,both,38,26.6,,,,,,,,,,,,,,,,,,,Other,13.44,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.68,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.68,13.44, "AIRWAY RESISTANCE PULSE OXIMETRY,TECHNICAL COMPONENT",94728,HCPCS,960,RC,26,,,both,34,23.8,,,,,,,,,,,,,,,,,,,Other,13.78,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,11.99,13.78, "DIFFUSING CAPACITY,TECHNICAL COMPONENT",94729,HCPCS,960,RC,26,,,both,25,17.5,,,,,,,,,,,,,,,,,,,Other,10.5,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.12,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.12,10.5, SKIN TESTING INTRACUTANEOUS,95028,HCPCS,940,RC,,,,both,42,29.4,,,,,,,,,,,,,,,,,,,Other,9.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,9.06,11.27, ALLERGY INJECTION SINGLE,95115,HCPCS,940,RC,,,,both,29,20.3,,,,,,,,,,,,,,,,,,,Other,6.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,9.48,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,6.25,9.48, ALLERGY INJECTIONS 2 OR MORE,95117,HCPCS,940,RC,,,,both,38,26.6,,,,,,,,,,,,,,,,,,,Other,8.19,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,11.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.19,11.27, "SLEEP LATENCY MULTIPLE STUDIES,TECHNICAL COMPONENT",95805,HCPCS,960,RC,26,,,both,205,143.5,,,,,,,,,,,,,,,,,,,Other,64.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,56.1,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,56.1,64.51, "SLEEP STUDY W/RESP EFFORT-O2-HRTRAT,TECHNICAL COMPONENT",95807,HCPCS,960,RC,26,,,both,194,135.8,,,,,,,,,,,,,,,,,,,Other,66.74,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,58.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,58.04,66.74, "SLEEP STUDY INTERP,TECHNICAL COMPONENT",95810,HCPCS,960,RC,26,,,both,433,303.1,,,,,,,,,,,,,,,,,,,Other,133.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,116.28,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,116.28,133.72, "SLEEP STUDY W/CPAP INTERP,TECHNICAL COMPONENT",95811,HCPCS,960,RC,26,,,both,494,345.8,,,,,,,,,,,,,,,,,,,Other,138.52,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,120.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,120.45,138.52, TENSILON TEST,95857,HCPCS,960,RC,,,,both,176,123.2,,,,,,,,,,,,,,,,,,,Other,27.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,62.7,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,27.08,62.7, DEVELOPMENTAL TESTING LIMITED W/IR,96110,HCPCS,940,RC,,,,both,60,42,,,,,,,,,,,,,,,,,,,Other,12.94,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,12.94,12.94, ADMIN THERAPEUTIC IM INJECTION,96372,HCPCS,940,RC,,,,both,62,43.4,,,,,,,,,,,,,,,,,,,Other,13.37,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.37,14.45, IV PUSH SINGLE OR INITIAL DRUG,96374,HCPCS,940,RC,,,,both,167,116.9,,,,,,,,,,,,,,,,,,,Other,36.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,34.71,36.01, IRRIGATION VENOUS ACCESS DEVICE,96523,HCPCS,940,RC,,,,both,108,75.6,,,,,,,,,,,,,,,,,,,Other,23.28,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,23.64,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.28,23.64, LASER TREATMENT FOR INFLAMMATORY SKIN DI,96920,HCPCS,960,RC,,,,both,432,302.4,,,,,,,,,,,,,,,,,,,Other,45.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,126.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,45.9,126.59, "ASST DEBRIDEMENT SKIN 1ST 20 SQ CM,ASSISTANT SURGEON",97597,HCPCS,960,RC,80,,,both,60,42,,,,,,,,,,,,,,,,,,,Other,5.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,5.7,15.05, DEBRIDEMENT SKIN 1ST 20 SQ CM,97597,HCPCS,975,RC,,,,both,188,131.6,,,,,,,,,,,,,,,,,,,Other,35.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,94.05,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,35.64,94.05, DEBRIDEMENT SKIN ADDTL OVER 20 SQ C,97598,HCPCS,975,RC,,,,both,127,88.9,,,,,,,,,,,,,,,,,,,Other,25.41,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,45.4,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,25.41,45.4, NEGATIVE PRESSURE WOUND THER EQUAL OR LE,97605,HCPCS,960,RC,,,,both,128,89.6,,,,,,,,,,,,,,,,,,,Other,23.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,39.41,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,23.67,39.41, NEG PRESSURE WND TX GREATER THAN 50CM,97606,HCPCS,960,RC,,,,both,161,112.7,,,,,,,,,,,,,,,,,,,Other,25.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,47.02,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,25.89,47.02, ACCUPUNCTURE W/O ELECTRICITY,97810,HCPCS,960,RC,,,,both,98,68.6,,,,,,,,,,,,,,,,,,,Other,31.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,45.62,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,31.16,45.62, TELEHEALTH AUDIO ONLY EST PT 10 MIN,98012,HCPCS,960,RC,,,,outpatient,88,61.6,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, TELEHEALTH AUDIO ONLY 20 MIN,98013,HCPCS,960,RC,,,,outpatient,145,101.5,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, TELEHEALTH AUDIO ONLY 30 MIN,98014,HCPCS,960,RC,,,,outpatient,200,140,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, TELEHEALTH AUDIO ONLY 40 MIN,98015,HCPCS,960,RC,,,,outpatient,250,175,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, BRIEF BY VIRTUAL CHECK IN,98016,HCPCS,960,RC,,,,outpatient,25,17.5,,,,,,,,,,,,,,,,,,,Other,14.88,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.82,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,14.88,16.82, URINE COLLECTION TRANSFER,99000,HCPCS,300,RC,,,,both,29,20.3,,,,,,,,,,,,,,,,,,,Other,6.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,6.25,6.25, DEPOSITION $550/1ST HR+,99075,HCPCS,960,RC,,,,both,550,385,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, EDUCATIONAL SERVICE,99078,HCPCS,942,RC,,,,both,111,77.7,,,,,,,,,,,,,,,,,,,Other,23.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,23.93,23.93, NEW OV EXPANDED 99202,99202,HCPCS,983,RC,,,,outpatient,145,101.5,,,,,,,,,,,,,,,,,,,Other,47.03,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,71.38,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,47.03,71.38, NEW OV DETAILED 99203,99203,HCPCS,983,RC,,,,outpatient,213,149.1,,,,,,,,,,,,,,,,,,,Other,82.7,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,113.16,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,82.7,113.16, NEW OV COMPREHENSIVE 99204,99204,HCPCS,983,RC,,,,outpatient,330,231,,,,,,,,,,,,,,,,,,,Other,134.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,171.2,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,134.68,171.2, NEW OV EXTENSIVE 99205,99205,HCPCS,983,RC,,,,outpatient,438,306.6,,,,,,,,,,,,,,,,,,,Other,185.23,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,229.52,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,185.23,229.52, EST OV FOCUSED 99211,99211,HCPCS,983,RC,,,,outpatient,45,31.5,,,,,,,,,,,,,,,,,,,Other,8.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,22.54,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,8.73,22.54, EST OV EXPANDED 99212,99212,HCPCS,983,RC,,,,outpatient,88,61.6,,,,,,,,,,,,,,,,,,,Other,35.73,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,56.47,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,35.73,56.47, EST OV DETAILED 99213,99213,HCPCS,983,RC,,,,outpatient,147,102.9,,,,,,,,,,,,,,,,,,,Other,65.57,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,90.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,65.57,90.79, EST OV COMPREHENSIVE 99214,99214,HCPCS,983,RC,,,,both,216,151.2,,,,,,,,,,,,,,,,,,,Other,96.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,129.78,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,96.67,129.78, EST OV COMPLEX 99215,99215,HCPCS,983,RC,,,,both,305,213.5,,,,,,,,,,,,,,,,,,,Other,143.53,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,184.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,143.53,184.58, HOSP/OBS VISIT INITIAL FOCUSED; 40 MIN,99221,HCPCS,987,RC,,,,both,240,168,,,,,,,,,,,,,,,,,,,Other,86.63,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,75.33,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,75.33,86.63, HOSP/OBS VISIT INITIAL DETAILED; 55 MIN,99222,HCPCS,987,RC,,,,both,293,205.1,,,,,,,,,,,,,,,,,,,Other,134.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,116.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,116.89,134.43, HOSPITAL/OBS VISIT INITIAL COMP; 75 MIN,99223,HCPCS,987,RC,,,,inpatient,430,301,,,,,,,,,,,,,,,,,,,Other,179.16,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,155.79,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,155.79,179.16, HOSP VISIT DAILY FOCUSED,99231,HCPCS,987,RC,,,,inpatient,93,65.1,,,,,,,,,,,,,,,,,,,Other,50.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,44,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,44,50.61, HOSP VISIT DAILY DETAILED,99232,HCPCS,987,RC,,,,inpatient,152,106.4,,,,,,,,,,,,,,,,,,,Other,80.66,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,70.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,70.14,80.66, HOSP VISIT DAILY COMPREHENSIVE,99233,HCPCS,987,RC,,,,both,244,170.8,,,,,,,,,,,,,,,,,,,Other,122.25,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,106.3,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,106.3,122.25, OBS IP OR OP H&P/DC SAME DAY DETAIL,99234,HCPCS,987,RC,,,,both,319,223.3,,,,,,,,,,,,,,,,,,,Other,101.68,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,88.43,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,88.43,101.68, OBS IP/OP SAME DAY ADMIT/DISCH INT,99235,HCPCS,987,RC,,,,both,391,273.7,,,,,,,,,,,,,,,,,,,Other,163.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,142.45,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,142.45,163.82, OBS IP/OP SAME DAY ADMIT/DISCH EXT,99236,HCPCS,987,RC,,,,inpatient,554,387.8,,,,,,,,,,,,,,,,,,,Other,218.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,189.65,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,189.65,218.1, HOSPITAL DISCHARGE,99238,HCPCS,987,RC,,,,inpatient,165,115.5,,,,,,,,,,,,,,,,,,,Other,84.83,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,73.76,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,73.76,84.83, HOSP DISCH MORE THAN 30 MIN,99239,HCPCS,987,RC,,,,inpatient,259,181.3,,,,,,,,,,,,,,,,,,,Other,120.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,104.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,104.86,120.59, OUT PATIENT CONSULT COMPREHENSIVE,99244,HCPCS,988,RC,,,,outpatient,386,270.2,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, IN PATIENT CONSULT EXPANDED,99252,HCPCS,983,RC,,,,inpatient,189,132.3,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, IN PATIENT CONSULT DETAILED,99253,HCPCS,988,RC,,,,inpatient,308,215.6,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, IN PATIENT CONSULT COMPREHENSIVE,99254,HCPCS,983,RC,,,,inpatient,391,273.7,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, IN PATIENT CONSULT EXTENSIVE,99255,HCPCS,983,RC,,,,inpatient,502,351.4,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, CRITICAL CARE 1ST HOUR,99291,HCPCS,960,RC,,,,both,721,504.7,,,,,,,,,,,,,,,,,,,Other,230.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,299.04,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,230.82,299.04, CRITICAL CARE HOUR ADDITIONAL,99292,HCPCS,960,RC,,,,both,374,261.8,,,,,,,,,,,,,,,,,,,Other,116.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,131.14,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,116.1,131.14, NH/SWING ADMIT DETAILED,99304,HCPCS,960,RC,,,,inpatient,176,123.2,,,,,,,,,,,,,,,,,,,Other,80.32,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,78.81,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,78.81,80.32, NH/SWING ADMIT COMPREHENSIVE,99305,HCPCS,960,RC,,,,inpatient,227,158.9,,,,,,,,,,,,,,,,,,,Other,135.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,137.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,135.98,137.06, NH/SWING ADMIT COMPLEX,99306,HCPCS,960,RC,,,,inpatient,290,203,,,,,,,,,,,,,,,,,,,Other,185.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,187.6,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,185.14,187.6, NH SWING VISIT FOCUSED,99307,HCPCS,960,RC,,,,inpatient,78,54.6,,,,,,,,,,,,,,,,,,,Other,41.67,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,40.71,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,40.71,41.67, NH SWING VISIT EXPANDED LOW COMP,99308,HCPCS,960,RC,,,,inpatient,122,85.4,,,,,,,,,,,,,,,,,,,Other,75.98,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,75.93,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,75.93,75.98, NH/SWING DETAILED MODERATE,99309,HCPCS,960,RC,,,,inpatient,171,119.7,,,,,,,,,,,,,,,,,,,Other,111.1,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,110.96,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,110.96,111.1, NH SWING VISIT COMPREHENSIVE HIGH,99310,HCPCS,960,RC,,,,inpatient,239,167.3,,,,,,,,,,,,,,,,,,,Other,158.65,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,158.58,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,158.58,158.65, DC NURSING FACILITY <=30,99315,HCPCS,960,RC,,,,inpatient,138,96.6,,,,,,,,,,,,,,,,,,,Other,82.39,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,82.99,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,82.39,82.99, DC NURSING FACILITY >30,99316,HCPCS,960,RC,,,,inpatient,204,142.8,,,,,,,,,,,,,,,,,,,Other,133.33,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,134.46,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,133.33,134.46, HOME VISIT DETAILED,99349,HCPCS,960,RC,,,,outpatient,195,136.5,,,,,,,,,,,,,,,,,,,Other,148,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,128.69,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,128.69,148, HOME VISIT COMPREHENSIVE,99350,HCPCS,960,RC,,,,outpatient,264,184.8,,,,,,,,,,,,,,,,,,,Other,216.31,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,188.09,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,188.09,216.31, INDIRECT CONTACT PROLONGED CARE 1ST HR,99358,HCPCS,960,RC,,,,outpatient,206,144.2,,,,,,,,,,,,,,,,,,,Other,122.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,106.53,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,106.53,122.51, INDIRECT PROLONGED CARE ADDTNL 30 MIN,99359,HCPCS,960,RC,,,,outpatient,137,95.9,,,,,,,,,,,,,,,,,,,Other,59.87,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,52.06,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,52.06,59.87, HOME HEALTH CARE PLAN OVERSIGHT,99375,HCPCS,960,RC,,,,outpatient,184,128.8,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, WELL CHILD NEW 1-4 YRS 99382,99382,HCPCS,510,RC,,,,outpatient,191,133.7,,,,,,,,,,,,,,,,,,,Other,41.18,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,41.18,41.18, WELL CHILD NEW 5-11 YRS 99383,99383,HCPCS,510,RC,,,,outpatient,203,142.1,,,,,,,,,,,,,,,,,,,Other,43.77,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,43.77,43.77, WELL CHILD NEW 12-17 YRS 99384,99384,HCPCS,510,RC,,,,outpatient,220,154,,,,,,,,,,,,,,,,,,,Other,47.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,47.43,47.43, WELL NEW PHYSICAL AGES 18-39 99385,99385,HCPCS,510,RC,,,,outpatient,260,182,,,,,,,,,,,,,,,,,,,Other,56.06,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,56.06,56.06, WELL EXAM NEW PT 40-64 99386,99386,HCPCS,510,RC,,,,outpatient,293,205.1,,,,,,,,,,,,,,,,,,,Other,63.17,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,63.17,63.17, WELL EXAM NEW PT AGE 65+ 99387,99387,HCPCS,510,RC,,,,outpatient,301,210.7,,,,,,,,,,,,,,,,,,,Other,64.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,64.9,64.9, WELL BABY ESTAB 0-1 YR 99391,99391,HCPCS,510,RC,,,,outpatient,164,114.8,,,,,,,,,,,,,,,,,,,Other,35.36,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,35.36,35.36, WELL CHILD ESTAB 1-4 YRS 99392,99392,HCPCS,510,RC,,,,outpatient,176,123.2,,,,,,,,,,,,,,,,,,,Other,37.95,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,37.95,37.95, WELL CHILD ESTAB 5-11 YR 99393,99393,HCPCS,510,RC,,,,outpatient,180,126,,,,,,,,,,,,,,,,,,,Other,38.81,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,38.81,38.81, WELL CHILD ESTAB 12-17 YR 99394,99394,HCPCS,510,RC,,,,outpatient,199,139.3,,,,,,,,,,,,,,,,,,,Other,42.9,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,42.9,42.9, WELL PREV EST 18-39 YR 99395,99395,HCPCS,510,RC,,,,outpatient,230,161,,,,,,,,,,,,,,,,,,,Other,49.59,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,49.59,49.59, WELL PREV EST AGE 40-64 99396,99396,HCPCS,510,RC,,,,outpatient,244,170.8,,,,,,,,,,,,,,,,,,,Other,52.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,52.61,52.61, WELL PREV EST AGE 65 + 99397,99397,HCPCS,510,RC,,,,outpatient,244,170.8,,,,,,,,,,,,,,,,,,,Other,52.61,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,52.61,52.61, SMOKING-TOB USE CESS COUNSEL 3-10,99406,HCPCS,960,RC,,,,both,29,20.3,,,,,,,,,,,,,,,,,,,Other,12.27,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,14.86,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.27,14.86, SMOKING-TOB USE CESS CONSELING >10,99407,HCPCS,960,RC,,,,both,55,38.5,,,,,,,,,,,,,,,,,,,Other,25.3,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,28.27,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,25.3,28.27, PROLONGED E&M VISIT EACH ADDNL 15 MINUTE,99417,HCPCS,960,RC,,,,outpatient,60,42,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, PROLONGED INPATIENT OR OBS EA ADDNL 15 M,99418,HCPCS,960,RC,,,,outpatient,50,35,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ONLINE E&M 5-10 MINUTES,99421,HCPCS,960,RC,,,,outpatient,38,26.6,,,,,,,,,,,,,,,,,,,Other,12.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,15.18,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.64,15.18, ONLINE E&M 11-20 MINUTES,99422,HCPCS,960,RC,,,,outpatient,73,51.1,,,,,,,,,,,,,,,,,,,Other,25.64,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,29.77,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,25.64,29.77, ONLINE E&M 21 OR MORE MINUTES,99423,HCPCS,960,RC,,,,outpatient,112,78.4,,,,,,,,,,,,,,,,,,,Other,39.93,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,46.97,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,39.93,46.97, CHRONIC CARE MANAGEMENT STAFF 1ST 20 MIN,99490,HCPCS,960,RC,,,,both,73,51.1,,,,,,,,,,,,,,,,,,,Other,50.01,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,63.51,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,50.01,63.51, TRANSITIONAL CARE MANAGEMENT 14 DAYS,99495,HCPCS,960,RC,,,,both,332,232.4,,,,,,,,,,,,,,,,,,,Other,139.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,208.91,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,139.54,208.91, TRANSITIONAL CARE WITHIN 7 DAYS,99496,HCPCS,960,RC,,,,both,440,308,,,,,,,,,,,,,,,,,,,Other,189.43,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,283.07,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,189.43,283.07, ADVANCE DIRECTIVE GUIDANCE FIRST 30 MINU,99497,HCPCS,960,RC,,,,both,152,106.4,,,,,,,,,,,,,,,,,,,Other,74.82,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,83.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,74.82,83.89, INITIAL FUNCTIONAL MEDICINE VISIT 45 MIN,960,RC,,,,,,outpatient,320,224,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FUNCTIONAL MEDICINE FOLLOW UP 30 MIN,960,RC,,,,,,outpatient,240,168,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, FUNCTIONAL MEDICINE EACH ADDNL 10 MIN,960,RC,,,,,,outpatient,120,84,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, ELECTIVE LASER PROCEDURE,969,RC,,,,,,outpatient,100,70,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, MICRONEEDLING FOR COSMETIC PURPOSES,969,RC,,,,,,outpatient,800,560,,,,,,,,,,,,,,,,,,,Other,,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,,, OPUS PLASMA SKIN RESURFACING,940,RC,,,,,,outpatient,800,560,,,,,,,,,,,,,,,,,,,Other,172.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,172.48,172.48, MNT INDIVIDUAL ASSESSMENT,97802,HCPCS,942,RC,,,,both,69.96,48.97,,,,,,,,,,,,,,,,,,,Other,15.08,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,34.59,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,15.08,34.59, MNT INDIVIDUAL FOLLOW-UP,97803,HCPCS,942,RC,,,,both,62.54,43.78,,,,,,,,,,,,,,,,,,,Other,13.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,29.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,13.48,29.89, MNT GROUP ASSESSMENT,97804,HCPCS,942,RC,,,,both,36.57,25.6,,,,,,,,,,,,,,,,,,,Other,7.89,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,16.17,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,7.89,16.17, MNT INDIVIDUAL REASSESSMENT CHANGE COND,G0270,HCPCS,942,RC,,,,both,59,41.3,,,,,,,,,,,,,,,,,,,Other,12.72,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",Fee Schedule,29.89,,"Reimbursement is based on the Medicare Professional Services Fee Schedule. Reimbursement is subject to modifier adjustments, multiple procedure reductions and mid-level provider adjustments when applicable. Reimbursement is subject to Medicare Sequestration.",,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,12.72,29.89, CAL COUNT,942,RC,,,,,,both,11.5,8.05,,,,,,,,,,,,,,,,,,,Other,2.48,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,2.48,2.48, EXCHANGE LIST FOR WEIGHT MANAGEMENT,270,RC,,,,,,both,5.25,3.68,,,,,,,,,,,,,,,,,,,Other,1.14,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.14,1.14, EXCHANGE LIST FOR MEAL PLANNING,270,RC,,,,,,both,6.5,4.55,,,,,,,,,,,,,,,,,,,Other,1.4,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.4,1.4, FIRST STEP IN DIABETES MEAL PLANNING,270,RC,,,,,,both,2.5,1.75,,,,,,,,,,,,,,,,,,,Other,0.54,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,0.54,0.54, GUEST TRAY,220,RC,,,,,,both,7,4.9,,,,,,,,,,,,,,,,,,,Other,1.51,,Reimbursement is based on the facility specific Medicare Interim Rate letter. Professional services billed on the hospital claim are paid at 115% of the Medicare Professional Fee Schedule rate. Reimbursement is subject to Medicare Sequestration.,,,,0,"Method II reimbursement for outpatient CAH services is 101 percent of the reasonable cost less applicable Part B deductible and coinsurance amounts. Under Method II, payment for professional medical services furnished in a CAH to CAH outpatients is reimbursed at 115% of what would otherwise be paid under the fee schedule. The item or service has not been billed on a claim for this payer and plan type in the past 12 months.",,,,,,,,,,,,,,,,,,,1.51,1.51, ICU ROOM,200,RC,,,,,,both,2540,1778,,,,,,,,,,,,,,,,,,,Per Diem,2826.98,,Reimbursement is subject to Medicare Sequestration.,,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,,,,,,,,,,2826.98,2826.98, ICU ISOLATION ROOM,200,RC,,,,,,both,2760,1932,,,,,,,,,,,,,,,,,,,Per Diem,2826.98,,Reimbursement is subject to Medicare Sequestration.,,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,,,,,,,,,,2826.98,2826.98, MONITOR ROOM,120,RC,,,,,,both,2120,1484,,,,,,,,,,,,,,,,,,,Per Diem,2826.98,,Reimbursement is subject to Medicare Sequestration.,,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,,,,,,,,,,2826.98,2826.98, ISOLATION ROOM,110,RC,,,,,,both,1700,1190,,,,,,,,,,,,,,,,,,,Per Diem,2826.98,,Reimbursement is subject to Medicare Sequestration.,,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,,,,,,,,,,2826.98,2826.98, SEMI PVT ROOM,120,RC,,,,,,both,1480,1036,,,,,,,,,,,,,,,,,,,Per Diem,2826.98,,Reimbursement is subject to Medicare Sequestration.,,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,,,,,,,,,,2826.98,2826.98, SWING BED ROOM,120,RC,,,,,,both,1380,966,,,,,,,,,,,,,,,,,,,Per Diem,2826.98,,Reimbursement is subject to Medicare Sequestration.,,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,,,,,,,,,,2826.98,2826.98, SWING BED ISOLATION ROOM,120,RC,,,,,,both,1380,966,,,,,,,,,,,,,,,,,,,Per Diem,2826.98,,Reimbursement is subject to Medicare Sequestration.,,,,0,The item or service has not been billed on a claim for this payer and plan type in the past 12 months.,,,,,,,,,,,,,,,,,,,2826.98,2826.98,